title: Favorable Long-term Outcome in Patients Submitted to Liver Transplantation After Downstaging of Hepatocellular Carcinoma According to a Brazilian Selection Protocol.
abstract: BACKGROUND
  In October 2008, the Brazilian Ministry of Health authorized listing of downstaged hepatocellular carcinoma (HCC) for liver transplantation, according to a standardized protocol. The aim of this study was to compare the outcome of patients submitted to liver transplantation after downstaging of HCC with the results other standard indications in Brazil.
  
  
  METHODS
  We conducted a retrospective analysis of 2,667 adult 1st elective deceased-donor liver transplantations registered at the database of the Transplant Notification Center of the São Paulo State Health Secretariat. These cases are classified into 3 groups: "cirrhosis," including 1,709 patients transplanted because of end-stage liver disease; "Milan-HCC," including 873 HCC patients initially meeting the Milan criteria; and "downstaging" group, including 85 HCC patients submitted to tumor downstaging to the Milan criteria before liver transplantation.
  
  
  RESULTS
  One-, 3-, 5-, and 6-year patients survivals were, respectively, 82.7%, 72.0%, 66.1%, and 66.1%, in the "downstaging" group and 76.7%, 68.4%, 63.9%, and 63.5% in the "Milan-HCC" group (P = .483). At the same time intervals, patient survivals were 67.8%, 62.9%, 60.9%, and 60.2% in the "cirrhosis" group. These probabilities were significantly lower than those of both "downstaging" (P = .047) and "Milan-HCC" (P = .001) groups.
  
  
  CONCLUSIONS
  Patients submitted to liver transplantation after downstaging of HCC, according to a Brazilian selection protocol, present long-term outcomes similar to HCC patients initially within the Milan criteria and better survival than recipients with end-stage liver disease.
authors.affiliation: Transplant Service, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil; Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: pmassarollo@gmail.com.
authors.forename: P C B
authors.initials: PC
authors.lastname: Massarollo
authors.affiliation: Transplant Service, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
authors.forename: A Z
authors.initials: AZ
authors.lastname: Coppini
authors.affiliation: Transplant Service, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil; Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: A A
authors.initials: AA
authors.lastname: Salzedas-Netto
authors.affiliation: Transplant Service, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil; Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: F F
authors.initials: FF
authors.lastname: Coelho
authors.affiliation: Transplant Service, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
authors.forename: T
authors.initials: T
authors.lastname: Minami
authors.affiliation: Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: A M
authors.initials: AM
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D001938:Brazil; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome