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

肝细胞癌（HCC）肝移植的主要问题是肿瘤复发。肿瘤复发的大部分原因是癌细胞从天然肝脏扩散到体循环和免疫抑制剂。已经通过h-TERT mRNA的聚合酶链反应检测循环癌细胞，但其临床意义仍不清楚。因此，我们探讨了术前免疫化疗的活体相关供体肝移植（LRDLT）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，每周一次全身给予阿霉素10mg，连续三天门静脉注射5FU 250mg，我们称之为“三明治”化疗”，在 LRDLT 后第 7 天作为单一疗程开始。 FK506 和泼尼松龙在 LRDLT 后用作免疫抑制剂。肝动脉重建后立即开始通过门静脉转移供血。从第1天开始，通过门静脉输注50ml或100ml供体血液，几乎每周进行一次。LRDLT后，通过门静脉进行8次供体特异性输血（DST）接种。该方案可能会减少术前循环癌细胞并预防术后移植肝的微转移。此外，在本临床病例中，通过门静脉进行术中和术后药敏试验使免疫抑制剂的用量迅速减少。这些结果对于扩大不可切除的晚期 HCC 的适应症而言可能是个好消息，并可能为移植免疫学引入额外的解决方案。尽管有辅助免疫化疗，偏离米兰标准的 HCC 患者肝移植的预后可能很差。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肝癌，肝移植也可能有效。较少的

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