Liver transplantation for hepatocellular carcinoma: The impact of human immunodeficiency virus infection—21 plus 13
Liver transplantation for hepatocellular carcinoma: The impact of human immunodeficiency virus infection—21 plus 13
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DOI：
10.1002/hep.24287
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发表时间：
2011-06
期刊：
影响因子：
13.5
通讯作者：
U. Baccarani;G. Adani;M. Tavio;P. Viale
中科院分区：
文献类型：
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作者：
U. Baccarani;G. Adani;M. Tavio;P. Viale
我们饶有兴趣地阅读了Vibert等人最近发表在《HEPATOLOGY》上的文章。作者描述了他们在人类免疫缺陷病毒（HIV）阳性患者（21例）中进行肝移植治疗肝细胞癌（HCC）的单中心经验，并将这些患者与同样受HCC影响的HIV阴性患者（61例）进行比较。由于HIV阳性患者的辍学率较高（23.8%对11.4%），HIV感染在肝移植的意向治疗基础上损害了肝移植的结果，但对肝移植后的总生存期和无复发生存期没有显著影响。2005年至2010年，我中心为13例hiv阳性HCC患者进行了移植手术。该队列的特征见表1。与Vibert等人的病人不同的是，我们的病人没有一个被从等候名单上除名。没有出现HCC复发，尽管有3例患者未达到米兰标准（23%）；其中仅有1例（7.7%）微血管侵犯。根据edmonson - steiner的报告，77%为2级HCC， 23%为3级HCC。经病理分析，肝细胞癌结节的平均数目和总直径分别为2 61 1和46 6 29 mm。移植前，所有患者均行经动脉化疗栓塞或经动脉化疗栓塞联合射频消融治疗；病理分析肝细胞癌结节的平均坏死值为67% ~ 39%。最后，1、3、5年患者和移植物存活率分别为84.6%、84.6%、70.5%、84.6%、84.6%和84.6%，中位随访时间为35个月（1⁄4 ~ 73个月）。总之，我们的经验似乎与Vibert等人报道的经验相当，除了没有HCC复发，在法国队列中调查的患者中有23.8%存在HCC复发。
We read with interest the article by Vibert et al. recently published in HEPATOLOGY. The authors described their single-center experience with liver transplantation for hepatocellular carcinoma (HCC) in human immunodeficiency virus (HIV)–positive patients (21 cases) and compared those patients to HIV-negative patients (61 cases) who were also affected by HCC. Because of the higher dropout rate among the HIV-positive patients (23.8% versus 11.4%), HIV infection impaired the results of liver transplantation for HCC on an intent-to-treat basis but had no significant impact on overall survival and recurrence-free survival after liver transplantation. In our center from 2005 to 2010, we performed transplantation for 13 HIV-positive patients affected by HCC. The characteristics of this cohort are reported in Table 1. Unlike Vibert et al.’s patients, none of our patients were dropped from the waiting list. None experienced HCC recurrence, although three patients were outside the Milan criteria at listing (23%); only one of those patients (7.7%) had microvascular invasion. Seventy-seven percent had grade 2 and 23% had grade 3 HCC according to Edmondson-Steiner. The mean number and total diameter of the HCC nodules were 2 6 1 and 46 6 29 mm, respectively, upon pathological analysis. Before transplantation, all patients were treated with transarterial chemoembolization or combined transarterial chemoembolization and radio frequency ablation; the mean necrosis value was 67% 6 39% for the HCC nodules upon pathological analysis. Finally, the 1-, 3-, and 5-year patient and graft survival rates were 84.6%, 84.6%, and 70.5% and 84.6%, 84.6%, and 84.6%, respectively, with a median follow-up of 35 months (range 1⁄4 2-73 months). In conclusion, our experience seems to be comparable to the experience reported by Vibert et al. except for the absence of HCC recurrence, which was present in 23.8% of the patients investigated in the French cohort.