De novo hepatocellular carcinoma developing in the living donor liver grafts: A Japanese multicenter experience
De novo hepatocellular carcinoma developing in the living donor liver grafts: A Japanese multicenter experience
复制标题
活体肝移植中发生的新发肝细胞癌：日本多中心经验
作者：
Goto R;Kosai-Fujimoto Y;Yagi S;Kobayashi T;Akamatsu N;Shimamura T;Imura S;Ogiso S;Mizuno S;Takatsuki M;Fukuhara T;Kanto T;Eguchi S;Yanaga K;Ogura Y;Fukumoto T;Shimada M;Hasegawa K;Ohdan H;Uemoto S;Soejima Y;Ikegami T;Yoshizumi T;Tak
直接作用于丙型肝炎病毒的抗病毒药物降低了失代偿风险。用于移植的免疫抑制剂增加了新发恶性肿瘤发生的风险。我们评估了活体供体肝移植（LDLT）后新发肝细胞癌（HCC）的可能性和风险因素。方法我们回顾性评估了从日本9个主要肝移植中心收集的2779例成人病例中移植物中发生HCC的数据，包括LDLT后转移性HCC。结果在2779名LDLT成人受者中，34人（1.2%）在移植物中发生了HCC。在34例中，5例HCC似乎是新发的，因为肿瘤检测时间较长（9.7 [6.4-15.4]年），并且2例受体的自体肝脏内没有HCC。5例原发性肝癌中有3例的供体来源通过切除组织中的微卫星分析得到证实。所有5例患者的原发病均为丙型肝炎病毒相关肝硬化，其中2例接受了直接作用抗病毒药物治疗。在B型肝炎核心抗体阳性移植物中，5例中有4例发生原发性HCC。原发性肝癌预后良好，5例中有4例完全缓解。然而，复发性肝癌（n= 29）在移植物中有一个较差的结果，特别是在患者的中性粒细胞与淋巴细胞的比例评分超过4（中位生存时间，262 [19-463]天）。对于原发性HCC风险较高的LDLT受者，包括那些移植物为B型肝炎核心抗体阳性的受者，应仔细监测移植肝。
AimDirect‐acting antivirals for hepatitis C virus have reduced the decompensation risk. Immunosuppressants for transplantation raise the risk of occurrence of de novo malignancies. We assessed the probabilities of and risk factors for de novo hepatocellular carcinoma (HCC) development post‐living donor liver transplantation (LDLT).MethodsWe retrospectively evaluated the data of developed HCC in a graft including metastatic HCC post‐LDLT from 2779 adult cases collected from nine major liver transplantation centers in Japan.ResultsOf 2779 LDLT adult recipients, 34 (1.2%) developed HCCs in their grafts. Of 34, five HCCs appeared to be de novo because of a longer period to tumor detection (9.7 [6.4–15.4] years) and no HCC within the native liver of the two recipients. The donor origin of three of five de novo HCCs was confirmed using microsatellite analysis in resected tissue. Primary disease of all five was hepatitis C virus‐related cirrhosis, of which two were treated with direct‐acting antivirals. Four of five developed HCC de novo in the hepatitis B core antibody‐positive grafts. De novo HCCs had favorable prognosis; four of five were cured with complete remission. However, recurrent HCC (n= 29) in the graft had a poorer outcome, especially in patients with neutrophil to lymphocyte ratio scores above 4 (median survival time, 262 [19–463] days).ConclusionAnalysis of the database from major liver transplantation institutes in Japan revealed that de novo HCCs determined by microsatellite analysis were rarely detected, but the majority were successfully treated. LDLT recipients with higher risks of de novo HCC, including those with hepatitis B core antibody‐positive grafts, should be carefully followed by surveillance of the liver graft.