Cillo Umberto, Vitale Alessandro, Volk Michael L, Frigo Anna Chiara, Feltracco Paolo, Cattelan Annamaria, Brancaccio Giuseppina, Feltrin Giuseppe, Angeli Paolo, Burra Patrizia, Lonardi Sara, Trapani Silvia, Cardillo Massimo
Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, Padua University Hospital, 35128 Padua, Italy.
Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA 92354, USA.
Cancers (Basel). 2021 Mar 19;13(6):1416. doi: 10.3390/cancers13061416.
The COVID-19 pandemic caused temporary drops in the supply of organs for transplantation, leading to renewed debate about whether T2 hepatocellular carcinoma (HCC) patients should receive priority during these times. The aim of this study was to provide a quantitative model to aid decision-making in liver transplantation for T2 HCC. We proposed a novel ethical framework where the individual transplant benefit for a T2 HCC patient should outweigh the harm to others on the waiting list, determining a "net benefit", to define appropriate organ allocation. This ethical framework was then translated into a quantitative Markov model including Italian averages for waiting list characteristics, donor resources, mortality, and transplant rates obtained from a national prospective database (n = 8567 patients). The net benefit of transplantation in a T2 HCC patient in a usual situation varied from 0 life months with a model for end-stage liver disease (MELD) score of 15, to 34 life months with a MELD score of 40, while it progressively decreased with acute organ shortage during a pandemic (i.e., with a 50% decrease in organs, the net benefit varied from 0 life months with MELD 30, to 12 life months with MELD 40). Our study supports the continuation of transplantation for T2 HCC patients during crises such as COVID-19; however, the focus needs to be on those T2 HCC patients with the highest net survival benefit.
新冠疫情导致用于移植的器官供应暂时减少，引发了关于T2期肝细胞癌（HCC）患者在此期间是否应获得优先考虑的新一轮辩论。本研究的目的是提供一个定量模型，以辅助T2期HCC肝移植的决策。我们提出了一个新的伦理框架，即T2期HCC患者的个体移植获益应超过对等待名单上其他人的伤害，确定一个“净获益”，以定义合适的器官分配。然后，这个伦理框架被转化为一个定量马尔可夫模型，该模型纳入了意大利等待名单特征、供体资源、死亡率和移植率的平均值，这些数据来自一个全国性前瞻性数据库（n = 8567例患者）。在通常情况下，T2期HCC患者移植的净获益从终末期肝病（MELD）评分为15时的0个生命月，到MELD评分为40时的34个生命月不等，而在疫情期间急性器官短缺时，净获益会逐渐降低（即器官减少50%时，净获益从MELD评分为30时的0个生命月，到MELD评分为40时的12个生命月）。我们的研究支持在新冠疫情等危机期间继续为T2期HCC患者进行移植；然而，重点应放在净生存获益最高的那些T2期HCC患者身上。
