Resumen

Hepatocellular carcinoma (HCC) is the third most common cause of cancer mortality world-wide. Despite the success in the treatment of hepatitis C and the reduction of hepatitis B in Asia due to immunization programs the incidence of HCC will increase in Europe, North and Southamerica and Asia. This trend is due to the dramatic increase in Non-alcoholic fatty liver disease (NAFLD/NASH), which is becoming more and more important in the development of HCC.3 Disease related mortality of HCC is still high, since curative treatment options beside resection and liver transplantation (LT) are lacking. In patients with advanced liver disease and cirrhosis LT is the only curative option. Limitations of treating HCC with LT are the risk of tumor recurrence after LT and the relative organ shortage which causes a competition for organs between patients with HCC and non-malignant end stage liver diseases. 1996 Mazzaferro, et al. defined size criteria for HCCpatients suitable for LT (Milan-criteria), which were extended by the UCSF group in 2001 (San-Francisco-criteria). Both criteria were based on size and number of individual HCC-nodules in the liver. Organ allocation was switched to the MELD system in the most countries in 2002 and 2003, which raised the question how to deal with HCC patients waiting for a transplant with good liver function and consecutively low MELD. Extrapoints (exceptional MELD) were introduced to deal with this issue. First the points were allocated adjusted to an estimated three-months mortality causing a disadvantage for patients with non-malignant liver diseases. The system was modified over time successive increasing the waiting time for patients with HCC in order to overcome a disadvantage for patients with non-malignant liver disease.

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2017-05-03   |   345 visitas   |   Evalua este artículo 0 valoraciones

Vol. 16 Núm.3. Mayo-Junio 2017 Pags. 326-327 Ann Hepatol 2017; 16(3)