title: What is the probability of being too old for salvage transplantation after hepatocellular carcinoma resection?
abstract: BACKGROUND
  The strategy of salvage transplantation for patients with hepatocellular carcinoma is based on the premise that tumour recurrence will be still transplantable at the time of recurrence. However, patients can not only present non-transplantable recurrence but can also be over the age limit accepted for transplantation.
  
  
  OBJECTIVE
  To measure the risk of being too old for salvage transplantation of patients resected for hepatocellular carcinoma within Milan criteria.
  
  
  METHODS
  A Markov simulation model was developed on the basis of published literature.
  
  
  RESULTS
  The risk of being too old for salvage transplantation depends on the time-span between age at hepatic resection and age limit, and the expected median waiting-time. Patients resected at an age 2 or 3 years below the age limit carry a risk of being too old that overcomes the probability of receiving transplantation. Salvage strategy can cause harm that depends on the tumour characteristics and degree of portal hypertension, becoming maximal for patients with multiple tumours, clinical signs of portal hypertension and increased bilirubin levels.
  
  
  CONCLUSIONS
  The best strategy to adopt should be balanced between the risk of being too old and the expected transplant benefit, but salvage strategy could be pursued if it did not turn into significant harm in comparison to primary transplantation.
authors.affiliation: Liver and Multiorgan Transplant Unit, S.Orsola Hospital, University of Bologna, Italy. aleqko@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Morelli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Sara
authors.initials: S
authors.lastname: Pellegrini
authors.forename: Virginia
authors.initials: V
authors.lastname: Erroi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Bigonzi
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000367:Age Factors; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008390:Markov Chains; D012306:Risk; D016879:Salvage Therapy; D013997:Time Factors; D014850:Waiting Lists