Liver Transplantation for Hepatocellular Carcinoma in the Model for End-Stage Liver Disease Era
Liver Transplantation for Hepatocellular Carcinoma in the Model for End-Stage Liver Disease Era
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DOI：
10.1016/j.jamcollsurg.2010.01.007
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发表时间：
2010-05-01
影响因子：
5.2
通讯作者：
Livingstone, Alan S.
中科院分区：
文献类型：
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作者：
Levi, David M.;Tzakis, Andreas G.;Livingstone, Alan S.
背景技术背景：自2002年3月以来，器官共享联合网络肝脏分配政策给予符合特定医疗标准的肝细胞癌（HCC）患者额外优先权。本研究回顾了我们的经验，肝移植治疗HCC under this system.Study Design：2002年3月至2009年4月，244例HCC患者接受了原发性肝或肝肾移植根据目前的分配系统在迈阿密大学。回顾性评估了包括HCC无复发生存期（RFS）和患者生存期（PS）在内的结局。预测结果的临床变量进行了分析。结果：从上市到移植的中位时间为48天。中位随访时间为27.4个月，观察到的复发率为10.7%。移植后1、3、5年的RFS率分别为96.0%、89.0%和83.6%。移植后1年、3年和5年的PS率分别为86.3%、71.5%和61.7%。在诊断为T2肝癌的患者中，观察到接受术前消融治疗的患者RFS有改善的趋势; PS相似（p > 0.05）。T3期HCC患者的结局（RFS和PS）与T2期HCC患者相似（p > 0.05）。甲胎蛋白>100 ng/mL的患者的所有RFS均劣于甲胎蛋白
BACKGROUND: Since March 2002, the United Network for Organ Sharing liver allocation policy has given extra priority to patients with hepatocellular carcinoma (HCC) who meet specific medical criteria. This study reviews our experience with liver transplantation for HCC under this system.STUDY DESIGN: Between March 2002 and April 2009, 244 patients with HCC underwent primary liver or liver-kidney transplantation under the current allocation system at the University of Miami. Outcomes including HCC recurrence-free survival (RFS) and patient survival (PS) were assessed retrospectively. Clinical variables that predicted outcomes were analyzed.RESULTS: The median time from listing to transplantation was 48 days. The median follow-up was 27.4 months, with an observed recurrence rate of 10.7%. The RFS rates at 1, 3, and 5 years after transplantation were 96.0%, 89.0%, and 83.6%, respectively. The PS rates at 1, 3, and 5 years after transplantation were 86.3%, 71.5%, and 61.7%, respectively. Among patients diagnosed with T2 HCC, a trend toward improved RFS was observed for those who received preoperative ablative therapy; PS was similar (p > 0.05). Outcomes (RFS and PS) for patients with T3 HCC were similar to those in patients with T2 HCC (p > 0.05). Patients with an alpha-fetoprotein >100 ng/mL had all RFS that was inferior to that in patients with an alpha-fetoprotein