Living donor liver transplantation for hepatocellular carcinoma
Living donor liver transplantation for hepatocellular carcinoma
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DOI：
10.1053/j.gastro.2004.09.042
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发表时间：
2004-11-01
期刊：
影响因子：
29.4
通讯作者：
Abecassis, M
中科院分区：
文献类型：
--
作者：
Kulik, L;Abecassis, M
在美国，肝细胞癌（HCC）的发病率正以惊人的速度增长，以至于HCC已成为肝移植的重要指征。肝移植在HCC患者中的作用在过去的20年中不断发展，移植已成为HCC患者的少数治愈性治疗方式之一，特别是在选定的肿瘤良好的患者中。成人受体活体肝移植的出现提供了另一种治疗途径，特别是对于那些因当前死亡供体移植物分配算法而处于不利地位的HCC患者。活体供体移植可以限制等待时间，因此可以减少疾病的进展，因此直观地说，复发率应该低于等待已故供体器官的受体。关于活体肝移植治疗HCC的有效性的数据有限。基于在西北大学医学中心接受肝细胞癌移植的有限患者队列，在通过进行活体供体移植加速（“快速跟踪”）移植的受者中发现了更高的复发率，尤其是在肝细胞癌患者因分配算法而处于不利地位的时代。显然，活体肝移植在HCC患者管理中的作用需要对接受死亡或活体肝移植的HCC患者队列的复发率和脱落率进行前瞻性直接分析。
The incidence of hepatocellular carcinoma (HCC) is increasing at an alarming rate in the United States, such that HCC has become an important indication for liver transplantation. The role of liver transplantation in patients with HCC has evolved over the past 2 decades, and transplantation has become one of the few curative treatment modalities for patients with HCC, especially in selected patients with favorable tumors. The advent of living donor liver transplantation for adult recipients provides another therapeutic venue, in particular for patients with HCC who are disadvantaged by current allocation algorithms for grafts from deceased donors. Living donor transplantation may limit the waiting time and, as a result, may decrease the progression of disease so that intuitively the recurrence rate should be lower than for recipients who wait for an organ from a deceased donor. There are limited data on the efficacy of living donor liver transplantation in the setting of HCC. Based on a limited cohort of patients undergoing transplantation for HCC at Northwestern University Medical Center, a higher recurrence rate, stage for stage, was found in recipients whose transplants were accelerated ("fast-tracked") by performing a living donor transplant, especially in the era in which patients with HCC were disadvantaged by the allocation algorithm. Clearly, the role of living donor liver transplantation in management of patients with HCC requires prospective direct analysis of both recurrence and dropout rates in comparable patient cohorts with HCC undergoing either deceased or living donor liver transplantation.