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 21 November 2017

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News

Immediate listing for liver transplantation vs standard care in alcoholic cirrhosis

This month’s Annals of Internal Medicine compares immediate listing for liver transplantation with standard care for Child–Pugh stage B alcoholic cirrhosis.

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Liver transplantation improves survival of patients with end-stage (Child–Pugh stage C) alcoholic cirrhosis, but its benefit for patients with stage B disease is uncertain.

Dr Claire Vanlemmens and colleagues evaluated the outcomes of patients with Child–Pugh stage B alcoholic cirrhosis who are immediately listed for liver transplantation.

The team compared the results with those of patients assigned to standard treatment with delay of transplantation until progression to stage C disease.

68% assigned to immediate listing for liver transplants
Hepatology

The research team designed a randomized, controlled trial involving 13 liver transplantation programs in France.

The research team identified 120 patients with Child–Pugh stage B alcoholic cirrhosis and no viral hepatitis, cancer, or contraindication to transplantation.

Patients were randomly assigned to immediate listing for liver transplantation or standard care.

The team’s main outcome was overall and cancer-free survival over 5 years.

The researchers found that 68% of patients assigned to immediate listing for liver transplantation, and 25% of those assigned to standard care received a liver transplant.

All-cause death and cirrhosis-related death did not statistically differ between the 2 groups.

The research team noted that that 5-year survival was 58% for those assigned to immediate listing versus 69% for those assigned to standard care.

In multivariate analysis, independent predictors of long-term survival were absence of ongoing alcohol consumption, recovery from Child–Pugh stage C, and baseline Child–Pugh score less than 8.

Immediate listing for transplantation was associated with an increased risk for extrahepatic cancer.

The team found that the 5-year cancer-free survival rate was 63% for patients who were immediately listed and 94% for those who received standard care.

Restriction of the study sample to alcoholic patients may limit the generalizability of results to other settings.

Dr Vanlemmens’ team concluded, “Immediate listing for liver transplantation did not show a survival benefit compared with standard care for Child–Pugh stage B alcoholic cirrhosis.”

“In addition, immediate listing for transplantation increased the risk for extrahepatic cancer.”

 

Ann Int Med 2009: 150(3): 153-161


05 February 2009

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