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Vol. 87. Núm. 3.
Páginas 133-138 (marzo 2010)
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Vol. 87. Núm. 3.
Páginas 133-138 (marzo 2010)
Acceso a texto completo
Usefulness of pre-surgical biopsy in selecting patients with hepatocellular carcinoma for liver transplant
Utilidad de la biopsia preoperatoria en la selección de pacientes con hepatocarcinoma para el trasplante hepático
Visitas
1299
Emilio Ramos Rubio
Autor para correspondencia
, Laura Llado Garriga
Unidad de Trasplante Hepático, Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, Barcelona, Spain
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Abstract

The selection of patients with hepatocellular carcinoma (HCC) for liver transplantation must be improved. One of the methods proposed to achieve this objective consists of including predictors of tumour aggressiveness to the decision making algorithm. The procedures that would enable this characteristic to be assessed, are: 1. Serum biomarkers, 2. Response to transarterial chemoembolisation and 3. Data on the tumour histology. In this review, the available data on the usefulness of each of these procedures are analysed. Special attention is given to the evidence associated with the possible usefulness of a preoperative biopsy. It can be concluded that a preoperative biopsy could be useful to indicate liver transplantation in patients with extended criteria, but not in patients that fulfil the Milan criteria. This scenario could soon change if the initial data on the prognostic value of some molecular markers of tumour progression are confirmed.

Keywords:
Hepatocellular carcinoma
Liver transplantation
Liver biopsy
Resumen

La selección de pacientes con hepatocarcinoma para el trasplante hepático es susceptible de mejorarse. Uno de los métodos propuestos para lograr este objetivo consiste en la incorporación al algoritmo decisorio de factores pronóstico de agresividad tumoral. Los procedimientos que permitirían valorar esta característica pueden agruparse en 3 categorías: a) biomarcadores séricos; b) respuesta a la quimioembolización, y c) datos de la histología tumoral. En este estudio de revisión se analizan los datos disponibles acerca de la utilidad de cada uno de estos tipos de marcadores, y se presta una especial atención a las evidencias relacionadas con la posible utilidad de una biopsia preoperatoria. Puede concluirse que la biopsia preoperatoria podría ser útil para indicar el trasplante hepático en pacientes con criterios expandidos, pero no en pacientes que cumplan los criterios de Milán. Este escenario podría cambiar en un futuro no muy lejano si se confirman los primeros datos del valor pronóstico de algunos parámetros de biología molecular.

Palabras clave:
Hepatocarcinoma
Trasplante hepático
Biopsia hepática
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Copyright © 2010. Asociación Española de Cirujanos
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