title: Immediate listing for liver transplantation versus standard care for Child-Pugh stage B alcoholic cirrhosis: a randomized trial.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To compare the outcomes of patients with Child-Pugh stage B alcoholic cirrhosis who are immediately listed for liver transplantation with those of patients assigned to standard treatment with delay of transplantation until progression to stage C disease.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  13 liver transplantation programs in France.
  
  
  METHODS
  120 patients with Child-Pugh stage B alcoholic cirrhosis and no viral hepatitis, cancer, or contraindication to transplantation.
  
  
  METHODS
  Patients were randomly assigned to immediate listing for liver transplantation (60 patients) or standard care (60 patients).
  
  
  METHODS
  Overall and cancer-free survival over 5 years.
  
  
  RESULTS
  Sixty-eight percent 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: 5-year survival was 58% (95% CI, 43% to 70%) for those assigned to immediate listing versus 69% (CI, 54% to 80%) for those assigned to standard care. In multivariate analysis, independent predictors of long-term survival were absence of ongoing alcohol consumption (hazard ratio, 7.604 [CI, 2.395 to 24.154]), recovery from Child-Pugh stage C (hazard ratio, 7.633 [CI, 2.392 to 24.390]), and baseline Child-Pugh score less than 8 (hazard ratio, 2.664 [CI, 1.052 to 6.746]). Immediate listing for transplantation was associated with an increased risk for extrahepatic cancer: The 5-year cancer-free survival rate was 63% (CI, 43% to 77%) for patients who were immediately listed and 94% (CI, 81% to 98%) for those who received standard care.
  
  
  CONCLUSIONS
  Restriction of the study sample to alcoholic patients may limit the generalizability of results to other settings.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  The French National Program for Clinical Research.
authors.affiliation: Centre Hosptialier Universitaire Jean Minjoz, Besançon, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Vanlemmens
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
authors.forename: Chantal
authors.initials: C
authors.lastname: Milan
authors.forename: Michel
authors.initials: M
authors.lastname: Messner
authors.forename: Anne
authors.initials: A
authors.lastname: Minello
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Perarnau
authors.forename: Marie-Anne Astrid
authors.initials: MA
authors.lastname: Piquet
authors.forename: Georges-Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.forename: Christine
authors.initials: C
authors.lastname: Silvain
authors.forename: Sophie
authors.initials: S
authors.lastname: Hillaire
authors.forename: Gérard
authors.initials: G
authors.lastname: Thiefin
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Vinel
authors.forename: Patrick
authors.initials: P
authors.lastname: Hillon
authors.forename: Estelle
authors.initials: E
authors.lastname: Collin
authors.forename: Georges
authors.initials: G
authors.lastname: Mantion
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Miguet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D005602:France; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult