Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma
Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma
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DOI：
10.1002/bjs.5528
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发表时间：
2007-01-01
影响因子：
9.6
通讯作者：
Wong, J.
中科院分区：
文献类型：
--
作者：
Lo, C. M.;Fan, S. T.;Wong, J.
背景资料：支持活体肝移植（LDLT）治疗早期肝细胞癌（HCC）的假设性研究假设LDLT和死亡供体肝移植（DDLT）后的结局相当。本研究的目的是比较LDLT和DDLT后的结果，并确定可能导致任何差异的因素。方法：本研究包括60例符合米兰或加州大学旧金山弗朗西斯科（UCSF）放射学标准并接受LDLT的患者结果：LDLT组的偶发肿瘤较少，移植前经动脉化疗栓塞率较低，但挽救性移植率较高。该组的等待时间较短，移植物重量与标准肝脏重量（GW：SLW）的比值较低。围手术期过程和组织病理学肿瘤大小，数量，等级和阶段是可比的。中位随访时间为33个月（范围4 - 120）。LDLT组的累积5年复发率为29%，DDIT组为0%（P = 0.029）。A GW：SLW比值≤ 0.6、挽救性移植、3个或3个以上肿瘤结节、显微镜下血管浸润和病理分期超出Milan或UCSF标准是重要的混杂风险因素。多变量分析确定了挽救性移植（相对危险度5.16（95%置信区间（c.i.）1.48 P = 0.010）和病理分期超过UCSF标准（相对危险度4.10（95% c.i. 1.02 16.48）; P = 0.047）作为复发的独立预测因素。结论：尽管标准的放射学选择标准的基础上的数量和大小，接受LDLT的肝癌患者有更多的复发，因为其他临床特征的选择偏差。
Background: Hypothetical studies that favour living donor liver transplantation (LDLT) for early hepatocellular carcinoma (HCC) assumed a comparable outcome after LDLT and deceased donor liver transplantation (DDLT). The aim of this study was to compare the outcome after LDLT with that after DDLT, and to identify factors that might account for any differences.Methods: The study included 60 patients who met the radiological Milan or University of California at San Francisco (UCSF) criteria and underwent LDLT (43 patients) or DDLT (17).Results: The LDLT group had fewer incidental tumours and a lower rate of pretransplant transarterial chemoembolization but a higher rate of salvage transplantation. Waiting time was shorter and graft weight to standard liver weight (GW: SLW) ratio was lower in this group. The perioperative course, and histopathological tumour size, number, grade and stage were comparable. Median follow-up was 33 (range 4-120) months. The cumulative 5-year recurrence rate was 29 per cent in the LDLT group and 0 per cent in the DDIT group (P = 0.029). A GW: SLW ratio of 0.6 or less, salvage transplantation, three or more tumour nodules, microscopic vascular invasion, and pathological stage beyond the Milan or UCSF criteria were significant confounding risk factors. Multivariable analysis identified salvage transplantation (relative risk 5.16 (95 per cent confidence interval (c.i.) 1.48 to 18.02); P = 0.010) and pathological stage beyond the UCSF criteria (relative risk 4.10 (95 per cent c.i. 1.02 to 16.48); P = 0.047) as independent predictors of recurrence.Conclusion: Despite standard radiological selection criteria based on number and size, patients who underwent LDLT for HCC had more recurrence because of selection bias for other clinical characteristics.