Adult living donor liver transplantation for patients with hepatocellular carcinoma -: Extending UNOS priority criteria
Adult living donor liver transplantation for patients with hepatocellular carcinoma -: Extending UNOS priority criteria
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DOI：
10.1097/01.sla.0000109022.32391.eb
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发表时间：
2004-02-01
影响因子：
9
通讯作者：
Schwartz, ME
中科院分区：
文献类型：
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作者：
Gondolesi, GE;Roayaie, S;Schwartz, ME
引言：特别是对于肝细胞癌（HCC）患者，活体供体肝移植（LDLT）改善了移植的可及性。我们报告了36例接受LDLT治疗的HCC患者的结果，中位随访时间为10年。方法：基础诊断包括：丙型肝炎（24），乙型肝炎(9)，隐源性肝硬化(1)，血色素沉着症(1)和原发性胆汁性肝硬化(1)。肿瘤大于或等于5cm的患者术中给予静脉注射阿霉素，每隔3周给予6个周期的阿霉素。移植后2年，每3个月随访一次CT扫描和甲胎蛋白水平。分析平均等待时间、移植前治疗、肿瘤变量和生存率。对肿瘤变量进行单因素和多因素分析；Kaplan-Meier和log rank用于比较存活率。P < 0.05被认为是显著的。结果：LDLT的平均等待时间为62天，而同期50例肝细胞癌尸体器官移植患者的平均等待时间为459天（P = 0.0001）。在平均450天的随访中，有10例因非肿瘤相关原因死亡，3例因复发死亡；另外3例患者也出现复发。在单因素和多因素分析中，双叶分布是唯一显著的肿瘤变量（P = 0.03, log rank = 0.02）。53%的患者超过了美国联合医疗中心的优先标准。1年和2年患者生存率分别为75%和60%。365天和730天的复发率分别为82%和74%。总的来说，在肝细胞癌患者（n = 12）中，活体供体移植和尸体移植在生存和复发方面没有统计学上的显著差异。结论：虽然三分之一的患者肿瘤面积为5 cm，但其复发率、患者生存和复发自由与尸体移植后的结果相当。LDLT允许早期或较大HCC患者及时移植。
Introduction: For patients with hepatocellular carcinoma (HCC) in particular, living donor liver transplant (LDLT) improves access to transplant. We report our results in 36 patients with HCC who underwent LDLT with a median follow-up >1 year.Methods: Underlying diagnoses included: hepatitis C (24), hepatitis B (9), cryptogenic cirrhosis (1), hemochromatosis (1), and primary biliary cirrhosis (1). Patients with tumors greater than or equal to 5 cm received IV doxorubicin intraoperatively and 6 cycles of doxorubicin at 3-week intervals. Patients were followed with CT scan and alpha-fetoprotein levels every 3 months for 2 years posttransplant. Mean waiting time, pretransplant treatment, tumor variables, and survival were analyzed. Univariate and multivariate analysis were done to analyze tumor variables; Kaplan-Meier and log rank were used to compare survivals. P < 0.05 was considered significant.Results: Mean wait for LDLT was 62 days, compared with 459 days in 50 patients with HCC transplanted with cadaveric organs during the same time period (P = 0.0001). At median follow-up of 450 days, there have been 10 deaths due to non-tumor-related causes and 3 deaths from recurrence; recurrence has also been observed in 3 other patients. On univariate and multivariate analysis, bilobar distribution was the only significant tumor variable (P = 0.03, log rank = 0.02). Fifty-three percent of patients exceeded UNOS priority criteria. One and two-year patient survivals were 75% and 60%, respectively. Freedom from recurrence at 365 and 730 days was 82% and 74%, respectively. Overall and in patients with HCC > 5 cm (n = 12), there were no statistically significant differences in survival or in freedom from recurrence between recipients of living donor and cadaveric grafts.Conclusion: Although one third of patients had tumors > 5 cm, the incidence of recurrence as well as patient survival and freedom from recurrence are comparable to results after cadaveric transplant. LDLT allows timely transplantation in patients with early or with large HCC.