Claire Vanlemmens, MD; Vincent Di Martino, MD, PhD; Chantal Milan, PhD; Michel Messner, MD; Anne Minello, MD, PhD; Christophe Duvoux, MD, PhD; Thierry Poynard, MD, PhD; Jean-Marc Perarnau, MD; Marie-Anne Astrid Piquet, MD, PhD; Georges-Philippe Pageaux, MD, PhD; Sébastien Dharancy, MD; Christine Silvain, MD; Sophie Hillaire, MD, PhD; Gérard Thiefin, MD; Jean-Pierre Vinel, MD; Patrick Hillon, MD; Estelle Collin, MSc; Georges Mantion, MD; Jean-Philippe Miguet, MD; the TRANSCIAL Study Group
Liver transplantation improves survival of patients with end-stage (Childâ€“Pugh stage C) alcoholic cirrhosis, but its benefit for patients with stage B disease is uncertain.
To compare the outcomes of patients with Childâ€“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.
Randomized, controlled trial.
13 liver transplantation programs in France.
120 patients with Childâ€“Pugh stage B alcoholic cirrhosis and no viral hepatitis, cancer, or contraindication to transplantation.
Patients were randomly assigned to immediate listing for liver transplantation (60 patients) or standard care (60 patients).
Overall and cancer-free survival over 5 years.
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 Childâ€“Pugh stage C (hazard ratio, 7.633 [CI, 2.392 to 24.390]), and baseline Childâ€“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.
Restriction of the study sample to alcoholic patients may limit the generalizability of results to other settings.
Immediate listing for liver transplantation did not show a survival benefit compared with standard care for Childâ€“Pugh stage B alcoholic cirrhosis. In addition, immediate listing for transplantation increased the risk for extrahepatic cancer.
The French National Program for Clinical Research.
Vanlemmens C, Di Martino V, Milan C, Messner M, Minello A, Duvoux C, et al. Immediate Listing for Liver Transplantation Versus Standard Care for Child–Pugh Stage B Alcoholic Cirrhosis: A Randomized Trial. Ann Intern Med. 2009;150:153–161. doi: 10.7326/0003-4819-150-3-200902030-00004
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Published: Ann Intern Med. 2009;150(3):153-161.
Gastroenterology/Hepatology, Hematology/Oncology, Liver Disease, Liver Transplantation, Tobacco, Alcohol, and Other Substance Abuse.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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