Living donor liver transplantation versus deceased donor liver transplantation for hepatocellular carcinoma: A meta-analysis
Living donor liver transplantation versus deceased donor liver transplantation for hepatocellular carcinoma: A meta-analysis
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活体肝移植与死者肝移植治疗肝细胞癌：一项荟萃分析
DOI：
10.1002/lt.23490
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发表时间：
2012-10-01
影响因子：
4.6
通讯作者：
He, Xiaoshun
中科院分区：
文献类型：
--
作者：
Liang, Wenhua;Wu, Linwei;He, Xiaoshun
由于器官严重短缺，活体肝移植（LDLT）为肝细胞癌（HCC）患者提供了一种及时的替代死亡供体肝移植（DDLT）的方法。然而，肝细胞癌LDLT后较高的复发率和适应证标准仍存在争议。通过进行定量荟萃分析，我们试图比较肝细胞癌患者LDLT和DDLT的生存结局和复发率。本研究纳入了通过全面文献检索确定的LDLT和DDLT治疗HCC的比较研究。评价的结局包括患者生存率、无复发生存率（RFS）和规定时间点的复发率。本研究纳入了7项研究，共1310例受试者。对于LDLT和DDLT接受者，我们发现患者的生存率相当[1年，OR = 1.03，95%置信区间（CI）= 0.62-1.73; 3年，OR = 1.07，95% CI = 0.77-1.48;和5年，OR = 0.64，95% CI = 0.33-1.24]和RFS率（1年OR = 0.86，95%CI = 0.54-1.38; 3年OR = 1.04，95%CI = 0.69-1.58; 5年OR = 1.11，95%CI = 0.70-1.77）。此外，我们发现LDLT和DDLT接受者之间的1年、3年或5年复发率无显著差异（1年，OR = 1.55，95%CI = 0.36-6.58; 3年，OR = 2.57，95%CI = 0.53-12.41; 5年，OR = 1.21，95%CI = 0.44-3.32）。亚组分析显示符合米兰标准的HCC患者结局相似。这些结果表明，对于HCC患者（尤其是符合米兰标准的患者），LDLT是一种可接受的选择，与DDLT相比，LDLT不会影响患者生存或增加HCC复发。肝移植18：1226-1236，2012。(c)2012年AASLD。
Because of the severe organ shortage, living donor liver transplantation (LDLT) offers a timely alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, the higher recurrence rate of HCC after LDLT and the indication criteria remain controversial. By conducting a quantitative meta-analysis, we sought to compare the survival outcomes and recurrence rates with LDLT and DDLT for patients with HCC. Comparative studies of LDLT and DDLT for HCC, which were identified by a comprehensive literature search, were included in this study. The evaluated outcomes included patient survival, recurrence-free survival (RFS), and recurrence rates at defined time points. Seven studies with a total of 1310 participants were included in this study. For LDLT and DDLT recipients, we found comparable patient survival rates [1 year, odds ratio (OR) = 1.03, 95% confidence interval (CI) = 0.62-1.73; 3 years, OR = 1.07, 95% CI = 0.77-1.48; and 5 years, OR = 0.64, 95% CI = 0.33-1.24] and RFS rates (1 year, OR = 0.86, 95% CI = 0.54-1.38; 3 years, OR = 1.04, 95% CI = 0.69-1.58; and 5 years, OR = 1.11, 95% CI = 0.70-1.77). Moreover, we found no significant differences in the 1-, 3-, or 5-year recurrence rates between LDLT and DDLT recipients (1 year, OR = 1.55, 95% CI = 0.36-6.58; 3 years, OR = 2.57, 95% CI = 0.53-12.41; and 5 years, OR = 1.21, 95% CI = 0.44-3.32). A subgroup analysis revealed similar outcomes for patients with HCC meeting the Milan criteria. These findings demonstrate that for HCC patients (especially those within the Milan criteria), LDLT represents an acceptable option that does not compromise patient survival or increase HCC recurrence in comparison with DDLT. Liver Transpl 18:1226-1236, 2012. (c) 2012 AASLD.