Selecting the Appropriate Downstaging and Bridging Therapies for Hepatocellular Carcinoma: What Is the Role of Transarterial Radioembolization? A Pooled Analysis.

BACKGROUND: Transarterial radioembolization in HCC for LT as downstaging/bridging has been increasing in recent years but some indication criteria are still unclear. METHODS: We conducted a systematic literature search of primary research publications conducted in PubMed, Scopus and ScienceDirect databases until November 2022. Relevant data about patient selection, HCC features and oncological outcomes after TARE for downstaging or bridging in LT were analyzed. RESULTS: A total of 14 studies were included (7 downstaging, 3 bridging and 4 mixed downstaging and bridging). The proportion of whole liver TARE was between 0 and 1.6%. Multiple TARE interventions were necessary for 16.7% up to 28% of the patients. A total of 55 of 204 patients across all included studies undergoing TARE for downstaging were finally transplanted. The only RCT included presents a higher tumor response with the downstaging rate for LT of TARE than TACE (9/32 vs. 4/34, respectively). Grade 3 or 4 adverse effects rate were detected between 15 and 30% of patients. CONCLUSIONS: TARE is a safe therapeutic option with potential advantages in its capacity to necrotize and reduce the size of the HCC for downstaging or bridging in LT.

The New Age of Organ Donation-What Factors Have an Influence on the Attitude of Older People? An Attitudinal Survey in Southeastern Spain.

Currently, more than half of all donors are aged over 65 years, and previous studies have shown that this group is less willing to support organ donation. Objective: to analyse the attitude of people aged over 65 years toward organ donation and transplantation (ODT) and to determine how their psychosocial profile affects their attitude. Study population: citizens residing in southeastern Spain older than 65 years of age. A representative sample was obtained, which was stratified by gender and geographical location (n = 420). A validated questionnaire about ODT was used. Statistical analysis: a bivariate analysis was performed using the X2 test and a multivariate analysis. The favourable attitude toward the donation of one's own organs was 53%. The psychosocial variables affecting attitude were mainly: having discussed ODT with one's family (p < 0.001) or friends (OR 2.223), acceptance of cremation (OR 2.508), and acceptance of an autopsy (OR 2.578). Citizens aged over 65 tend to have an unfavourable attitude toward the donation of their own organs. The lack of dialogue about ODT in social and family settings, and the attitude to the manipulation of one's own body after death, are aspects of a respondent's psychosocial profile, which influence this attitude.