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Schoenberg, Markus Bo; Ehmer, Ursula; Umgelter, Andreas; Bucher, Julian Nikolaus; Koch, Dominik Thomas; Boerner, Nikolaus; Niess, Hanno; Denk, Gerald; De Toni, Enrico Narciso; Seidensticker, Max; Andrassy, Joachim; Angele, Martin Kurt; Werner, Jens und Guba, Markus Otto (2021): Liver transplantation versus watchful waiting in hepatocellular carcinoma patients with complete response to bridging therapy - a retrospective observational study. In: Transplant International, Vol. 34, No. 3: pp. 465-473

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Abstract

Bridging therapy to prevent progression on the waiting list can result in a sustained complete response (sCR). In some patients, the liver transplantation (LT) risk might exceed those of tumor recurrence. We thus evaluated whether a watchful waiting (CR-WW) strategy could be a feasible alternative to transplantation (CR-LT). We performed a retrospective analysis of overall survival (OS) and recurrence-free survival (RFS) of patients with a sCR (CR > 6 months). Permitted bridging included thermoablation, resection, and combinations of either with transarterial chemoembolization. Patients were divided into the intended treatment strategies CR-WW and CR-LT. 39 (18.40%) sCR patients from 212 were investigated. 22 patients were treated with a CR-LT and 17 patients a CR-WW strategy. Five-year RFS was lower in the CR-WW than in the CR-LT group [53.3% (22.1%;77.0%) and 84.0% (57.6%;94.7%)]. 29.4% (5/17) CR-WW patients received salvage transplantation because of recurrence. OS (5-year) was 83.9% [56.8%;94.7%] after LT and 75.4% [39.8%;91.7%] after WW. Our analysis shows that the intuitive decision made by our patients in agreement with their treating physicians for a watchful waiting strategy in sCR can be justified. Applied on a larger scale, this strategy could help to reduce the pressure on the donor pool.

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