Hwang Shin, Lee Sung-Gyu, Joh Jae-Won, Suh Kyung-Suk, Kim Dong-Goo
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Liver Transpl. 2005 Oct;11(10):1265-72. doi: 10.1002/lt.20549.
Current selection criteria of liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) were derived from the outcomes of cadaveric donor LT (CDLT). We tried to assess the applicability of such criteria to living donor LT (LDLT) through a comparative study between CDLT and LDLT. We analyzed the outcomes of 312 HCC patients who underwent LT at 4 Korean institutions during 1992 to 2002. There were no gross differences of tumor characteristics between CDLT group (n = 75) and LDLT group (n = 237). Overall 3-year survival rate (3-YSR) was 61.1% after CDLT and 73.2% after LDLT including 38 cases of perioperative mortality. Comparison of HCC recurrence curves did not reveal any statistical difference between these 2 groups. Patient survival period till 50% mortality after HCC recurrence was 11 months after CDLT and 7 months after LDLT. Significant risk factors for HCC recurrence were alpha-fetoprotein level, tumor size, microvascular invasion, gross major vessel invasion, bilateral tumor distribution, and histologic differentiation in the LDLT group on univariate analysis, and tumor size, gross major vessel invasion, and histologic differentiation on multivariate analysis. Milan criteria were met in 70.4%: Their 3-YSR was 89.9% after CDLT and 91.4% after LDLT with exclusion of perioperative mortality. University of California San Francisco criteria were met in 77.7%: Their 3-YSR was 88.1% after CDLT and 90.6% after LDLT. In conclusion, we think that currently available selection criteria for HCC patients can be applicable to LDLT without change of prognostic power.
目前肝细胞癌（HCC）患者肝移植（LT）的选择标准源自尸体供肝肝移植（CDLT）的结果。我们试图通过CDLT与活体供肝肝移植（LDLT）的对比研究来评估这些标准对LDLT的适用性。我们分析了1992年至2002年期间在4家韩国机构接受LT的312例HCC患者的结果。CDLT组（n = 75）和LDLT组（n = 237）之间的肿瘤特征没有显著差异。CDLT后的总体3年生存率（3 - YSR）为61.1%，LDLT后的为73.2%，包括38例围手术期死亡病例。HCC复发曲线的比较未显示这两组之间有任何统计学差异。HCC复发后直至50%患者死亡的生存时间，CDLT后为11个月，LDLT后为7个月。单因素分析显示，LDLT组中HCC复发的显著危险因素为甲胎蛋白水平、肿瘤大小、微血管侵犯、大体主要血管侵犯、双侧肿瘤分布和组织学分化，多因素分析显示为肿瘤大小、大体主要血管侵犯和组织学分化。70.4%的患者符合米兰标准：排除围手术期死亡病例后，CDLT后的3 - YSR为89.9%，LDLT后的为91.4%。77.7%的患者符合加利福尼亚大学旧金山分校标准：CDLT后的3 - YSR为88.1%，LDLT后的为90.6%。总之，我们认为目前可用的HCC患者选择标准可适用于LDLT，且预后能力不变。
