Comparison Between Living Donor Liver Transplantation Recipients Who Met the Milan and UCSF Criteria After Successful Downstaging Therapies
Comparison Between Living Donor Liver Transplantation Recipients Who Met the Milan and UCSF Criteria After Successful Downstaging Therapies
复制标题
DOI：
10.1007/s11605-012-2019-y
复制
发表时间：
2012-11-01
影响因子：
3.2
通讯作者：
Yan, L. N.
中科院分区：
文献类型：
--
作者：
Lei, J. Y.;Yan, L. N.
对不能满足肝移植相关标准的肝受者引入了各种降期治疗，并报告了许多终点。最常用的标准是米兰标准和加州大学旧金山弗朗西斯科（UCSF）标准。然而，他们之间没有进行比较，我们试图找出活体肝移植（LDLT）我们对2003年1月至2009年3月在我们中心接受手术前降期治疗后符合米兰标准的患者和符合UCSF标准的患者进行了回顾性研究，这些患者被诊断为晚期肝细胞癌，接受了各种降级治疗一些患者符合米兰标准（第1组），一些患者符合UCSF标准（第2组）但不符合米兰标准。我们收集了两组的数据，然后比较了术前人口统计学数据、降级治疗、LDLT术中数据以及LDLT后的恢复和并发症。采用Kaplan-Meier分析比较存活率，仅44例（61.1%）患者符合肝移植标准，21例符合米兰标准（组1），23例符合UCSF标准但不符合米兰标准（组2）。44例患者均在我中心接受了右叶活体肝移植。两组基线特征差异无统计学意义。第1组每例患者的平均降级治疗次数为1.81 +/- 0.35，第2组为1.83 +/- 0.41（P = 0.928）。大多数患者仅接受一种降期治疗，经导管动脉化疗栓塞（TACE）是最常见的降期治疗。4例患者在降级治疗后出现并发症：右肝切除术后腹腔内出血，TACE后上消化道出血，切除术后胆瘘，服用索拉非尼后手足综合征。根据Clavien-Dindo系统分类，比较两组内LDLT后的所有并发症，第1组的并发症计算评分为1.48 ± 1.63，大于第2组（1.39 ± 1.64），但差异未达到统计学显著性（P = 0.865）。1、3、5年生存率分别为90.4%、76.2%、71.4%和91.3%、73.9%、69.6%（P > 0.05）. 7名患者（第1组3名，第2组4名）在中位72个月的随访期后出现肿瘤复发。两组的病理结果无显著差异，符合Milan或UCSF标准的受者在LDLT中接受成功的术前降期治疗后可以获得相同的结果。
Various downstaging therapies were introduced to liver recipients who could not meet the relative criteria for liver transplantation, and many endpoints were reported. The most common criteria used were the Milan criteria and the University of California, San Francisco (UCSF) criteria. However, no comparison was made between them, and we attempted to find possible differences between the living donor liver transplantation (LDLT) patients who met the Milan criteria and those who met the UCSF criteria after accepting preoperative downstaging therapies.We performed a retrospective study of all 72 patients at our center from January 2003 to March 2009 who were diagnosed with advanced hepatocellular carcinoma but accepted various downstaging therapies. Some patients met the Milan criteria (group 1), and some met the UCSF criteria (group 2) but not the Milan criteria. We collected the data from the two groups and then compared the preoperative demographic data, downstaging therapies, intraoperative data from LDLT, and the recovery and complications after LDLT. Survival rates were compared using Kaplan-Meier analysis.Only 44 patients (61.1 %) met the criteria for liver transplantation, 21 cases met the Milan criteria (group 1), and 23 cases met the UCSF criteria (group 2) but not the Milan criteria. All of the 44 patients accepted right lobe living liver donor liver transplantation in our center. The difference in the baseline characteristics between the two groups did not reach statistical significance. The mean number of downstaging treatments per patient was 1.81 +/- 0.35 in group 1 and 1.83 +/- 0.41 in group 2 (P = 0.928). Most of the patients received only one downstaging treatment, and transcatheter arterial chemoembolization (TACE) was the most common downstaging therapy. Four patients suffered complications after downstaging therapies: intra-abdominal hemorrhage after right hepatectomy, upper gastrointestinal hemorrhage after TACE, biliary fistula after resection, and hand-foot syndrome after taking sorafenib. All complications after LDLT, classified according to the Clavien-Dindo system, were compared within the two groups, and the calculated score of the complications in group 1 was 1.48 +/- 1.63, which was greater than that of group 2 (1.39 +/- 1.64), but this difference did not reach statistical significance (P = 0.865). The 1-, 3-, and 5-year survival rates were 90.4, 76.2, and 71.4 % in group 1 and 91.3, 73.9, and 69.6 % in group 2, respectively (P > 0.05). Seven patients (three in group 1 and four in group 2) had tumor recurrence after a median follow-up period of 72 months. The pathology findings were not different between the two groups.Recipients who meet the Milan or UCSF criteria after accepting successful preoperative downstaging therapy in LDLT can achieve the same result.