Immediate listing for liver transplantation versus standard care for Child-Pugh stage B alcoholic cirrhosis: a randomized trial

Source:
American College of Physicians
Publisher:
American College of Physicians
Publication date:
03 February 2009

Abstract

Bottom-line conclusion: Immediate listing for liver transplantation did not show a survival benefit compared with standard care for Child–Pugh stage B alcoholic cirrhosis. In addition, immediate listing for transplantation increased the risk for extrahepatic cancer. Patients with continued alcohol consumption had poorer outcome regardless of treatment received, and a Child-Pugh score greater than 7 was the cutoff value for predicting poor survival, whereas recovery from Child–Pugh stage C disease was associated with better survival.

Background and aims: Liver transplantation improves survival of patients with end-stage (Child–Pugh stage C) alcoholic cirrhosis, but its benefit for patients with stage B disease is uncertain. To compare the outcomes of patients with Child–Pugh stage B alcoholic cirrhosis who are immediately listed for liver transplantation with those of patients assigned to standard treatment with delay of transplantation until progression to stage C disease.

Method: 120 patients with Child–Pugh stage B alcoholic cirrhosis and no viral hepatitis, cancer, or contraindication to transplantation were randomly assigned to immediate listing for liver transplantation (60 patients) or standard care (60 patients).

Results: Sixty-eight percent of patients assigned to immediate listing for liver transplantation and 25% of those assigned to standard care received a liver transplant. All-cause death and cirrhosis-related death did not statistically differ between the 2 groups: 5-year survival was 58% (95% CI, 43% to 70%) for those assigned to immediate listing versus 69% (CI, 54% to 80%) for those assigned to standard care. In multivariate analysis, independent predictors of long-term survival were absence of ongoing alcohol consumption (hazard ratio, 7.604 [CI, 2.395 to 24.154]), recovery from Child–Pugh stage C (hazard ratio, 7.633 [CI, 2.392 to 24.390]), and baseline Child–Pugh score less than 8 (hazard ratio, 2.664 [CI, 1.052 to 6.746]). Immediate listing for transplantation was associated with an increased risk for extrahepatic cancer: The 5-year cancer-free survival rate was 63% (CI, 43% to 77%) for patients who were immediately listed and 94% (CI, 81% to 98%) for those who received standard care.

Citation: Vanlemmens C, Di Martino V, Milan C, Messner M, Minello A, Duvoux C, Poynard T, Perarnau JM, Piquet MA, Pageaux GP, Dharancy S, Silvain C, Hillaire S, Thiefin G, Vinel JP, Hillon P, Collin E, Mantion G, Miguet JP; TRANSCIAL Study Group.  Immediate listing for liver transplantation versus standard care for Child-Pugh stage B alcoholic cirrhosis: a randomized trial. Ann Intern Med 2009 Feb 3;150(3):153-61.

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