Resection And Partial LIver Transplantation With Delayed Hepatectomy for Hepatocellular Carcinoma

Korábbi kezelés

• Expected combined transplant
• Severe comorbidities, in particular severe cardiovascular or respiratory or renal pathology (at the discretion of the medical-surgical team)
• Patient who has received (or is due to receive) preoperative treatment with radioembolization on the right side, hepatectomy or radiotherapy near the hilum
• Patient who received (or should receive) preoperative treatment with anti-tyrosine kinase (TKI) less than three months ago
• Patients receiving or having received immunotherapy
  • Donor selection criteria:

Más betegség

• History of, liver transplant, surgical or radiological portocaval anastomosis
• History of major abdominal surgery (including hepatectomy)
• History of abdominal radiotherapy (extrahepatic)
• History of acute/chronic pancreatitis
• Portal or arterial thrombosis
• Hepatitis C viral load +
• Acute or chronic hepatitis B (not cured)
• HIV + serology
• Serology: anti-HBc negative, anti-HCV negative

Laborértékek

• Biological and hepatic assessment compatible with the realization of a split, in particular transaminases < 4 times the normal

Életkor

• 18 years ≤ age ≤ 65 years

Egyéb

• HCC located 1 cm away from the transection line required by the first stage hepatectomy
• patient with a pre-graft hepatic venous pressure gradient ≥ 20mmHg
• Ascites (clinical or radiological) less than 5 years ago
• Patient on anticoagulant treatment
• Brain-dead donor (no living donor)
• Hepatic, vascular and biliary anatomy compatible with performing a split. Analysis entrusted to the team that will carry out the split, and based on the scanner of the donor (to be available on the Biomedicine Agency website)
• Graft not assigned to a protocol requiring machine infusion.

• 18 years ≤ age ≤ 68 years
• Indication of LT for HCC validated in multidisciplinary meeting
• AFP score ≤ 2 (15)
• Body mass index < 30 kg/m2
• MELD score ≤ 15, without access to prioritization
• PET CT-choline and PET CT-FDG without sign of extra-hepatic localizaton
• Patient having been informed and able to give written consent to participate in the RAPID-HCC study
• Validation of the patient's inclusion in the RAPID-HCC protocol by the scientific committee