Saigal S, Norris S, Srinivasan P, Muiesan P, Rela M, Heaton N, O'Grady J
Institute of Liver Studies, King's College Hospital, London, UK.
Liver Transpl. 2001 Jan;7(1):11-5. doi: 10.1053/jlts.2001.20788.
Preexisting malignancy is considered a relative contraindication to orthotopic liver transplantation (OLT) because of the risk of tumor recurrence. The purpose of this study is to assess the outcome of OLT in patients with a preexistent malignant state. Of 1,097 OLTs performed between 1989 and 1999 at King's College Hospital (London, UK), 18 patients had a pretransplantation malignant state, including 6 cases of myeloproliferative disorder (MPD) presenting as Budd-Chiari syndrome. Those patients with solid-organ malignancies had their tumor detected at an early stage and underwent curative treatment before or during OLT. Patients were followed up for a median of 71 months (range, 1 to 119 months) post-OLT, and the rates of rejection and malignancy were compared with those of transplant recipients without preexisting malignancy during the same period. One patient had a recurrence of his primary malignancy (non-Hodgkin's lymphoma) after 27 months, whereas another patient developed a de novo posttransplant lymphoproliferative disorder after 57 months. One patient with MPD developed acute leukemia 72 months after OLT. In comparison, of 1,079 OLTs performed in patients without preexisting malignancy during the same period, there were 34 cases of de novo malignancies. The rate of rejection in patients with and without preexisting malignancy was similar. Successful medium-term outcome after OLT can be achieved in carefully selected patients with preexisting malignancy providing the malignancy is amenable to curative treatment before or at OLT. Primary MPDs responsible for Budd-Chiari syndrome should not be considered a contraindication to OLT.
由于存在肿瘤复发风险，既往存在恶性肿瘤被视为原位肝移植（OLT）的相对禁忌证。本研究的目的是评估存在既往恶性状态的患者接受OLT的结果。在1989年至1999年于英国伦敦国王学院医院进行的1097例OLT中，18例患者存在移植前恶性状态，其中6例骨髓增殖性疾病（MPD）表现为布加综合征。那些患有实体器官恶性肿瘤的患者在早期发现肿瘤，并在OLT前或OLT期间接受了根治性治疗。对患者进行OLT后中位随访71个月（范围1至119个月），并将排斥反应和恶性肿瘤发生率与同期无既往恶性肿瘤的移植受者进行比较。1例患者在27个月后原发性恶性肿瘤（非霍奇金淋巴瘤）复发，而另1例患者在57个月后发生了移植后新发淋巴增殖性疾病。1例MPD患者在OLT后72个月发生急性白血病。相比之下，同期1079例无既往恶性肿瘤患者接受OLT，有34例新发恶性肿瘤。有和无既往恶性肿瘤患者的排斥反应发生率相似。对于经过精心挑选、存在既往恶性肿瘤且其恶性肿瘤在OLT前或OLT时适合根治性治疗的患者，OLT后可实现成功的中期结果。导致布加综合征的原发性MPD不应被视为OLT的禁忌证。
