The new strategy of treatment for unresectable hepatocellular carcinoma in living related donor liver transplantation

肝移植治疗肝癌的主要问题是肿瘤复发。肿瘤复发的主要原因是癌细胞从原生肝脏扩散到体循环和免疫抑制剂。利用h-TERT mRNA的聚合酶链反应检测循环癌细胞，但其临床意义尚不清楚。因此，我们研究活体供肝移植（LRDLT）术前免疫化疗患者肿瘤复发与外周血h-TERT mRNA表达的关系。我们研究了新辅助免疫化疗（5FU+阿霉素+干扰素β(IFNβ)）和辅助化疗（阿霉素10mg /周1次，5FU 250mg连续3天）。我们称之为“三明治化疗”，在LRDLT后的第7天开始一个疗程。FK506和强的松龙用于免疫抑制。肝动脉重建后立即开始通过门静脉输送供血。从第1天开始，几乎每周一次通过门静脉输注50ml或100ml供血。在LRDLT后进行了8次经门静脉的供者特异性输血（DST）接种。该方案可减少术前循环癌细胞，防止术后微转移到移植物肝脏。此外，在本临床病例中，经门静脉给药的DST带来了免疫抑制剂的快速减少。这些结果可能是扩大晚期不可切除HCC适应症的好消息，并可能引入移植免疫学的额外解决方案。偏离米兰标准的HCC患者，尽管进行了辅助免疫化疗，但肝移植预后可能较差。然而，如果通过辅助免疫化疗消除循环癌细胞，即使对于偏离米兰标准的不可切除的HCC，肝移植也可能有效。少

Major problem of liver transplantation for hepatocellular carcinoma (HCC) is tumor recurrence. Most of reason for tumor relaps are dissemination of cancer cells from the native liver to systemic circulation and immunosuppressants. Detection of circulating cancer cells has been performed by polymerase chain reaction of h-TERT mRNA, however, its clinical significance is still unclear. Therefore we investigated about the relations tumor recurrence and h-TERT mRNA expression in peripheral blood in the patients underwent living related donor liver transplantation (LRDLT) with preoperative immunochemotherapy We investigated the neoadjuvant immunochemotherapy (5FU+adriamycin+Interferon β(IFNβ)) and adjuvant chemotherapy with systemic administration of 10mg of adriamycin once a week and intraportal treatment with 250mg of 5FU for three consecutive days, which we called "Sandwich chemotherapy", was started as a single course on day 7 after LRDLT. FK506 and prednisolone were used as immunosuppre … More ssants following LRDLT. Transfer of donor blood via the portal vein was started immediately after the reconstruction of hepatic artery. Transfusion of 50 ml or 100 ml of donor blood via the portal vein was performed almost once a week starting on day 1.Eight times of inoculation of donor specific transfusion (DST) via portal vain were performed after LRDLT. this regimen might reduce the preoperative circulating cancer cells and prevent the postperative micrometastasis to the graft graft liver. Moreover, intra-and postoperative administration of DST via the portal vein brought rapid reduction of immunosupressants in the present clinical case. These results may be glad tidings in terms of expanding the indications for unresectable advanced HCC and may introduce an additional solution to transplantation immunology. Prognosis of liver transplantation for HCC patients deviated from Milan Criteria might be poor in spite of adjuvant immunochemotherapy. however, if circulating cancer cells are eliminated by adjuvant immunochemotheray, liver transplantation may be effective even for unresectable HCC deviated from Milan Criteria. Less