Takada Yasutsugu, Ueda Mikiko, Ito Takashi, Sakamoto Seisuke, Haga Hironori, Maetani Yoji, Ogawa Kohei, Kasahara Mureo, Oike Fumitaka, Egawa Hiroto, Tanaka Koichi
Department of Transplantation and Immunology, Kyoto University, Kyoto, Japan.
Liver Transpl. 2006 Jun;12(6):912-9. doi: 10.1002/lt.20642.
Living donor liver transplantation (LDLT) has evolved to represent an important surgical strategy for patients with hepatocellular carcinoma (HCC). However, due to disadvantages, including donor risks and higher rates of perioperative complications, LDLT has been considered as a second-line treatment in Japan. The present study retrospectively evaluated clinical outcomes for 93 patients with HCC who underwent LDLT at our institute, including 44 patients who exceeded Milan criteria (MC). A total of 73 patients (78%) displayed a history of previous treatment for HCC using various nontransplant methods. Median follow-up was 24 months (range, 1-76 months). At 4 years after LDLT, overall patient survival rate was 64%, with similar rates for within-MC and over-MC groups (68% vs. 59%, respectively; P = 0.6548). However, cumulative recurrence rate was significantly higher in the over-MC group than in the within-MC group (35% vs. 15%, P = 0.0190). Regarding history of conventional treatment for HCC before LDLT, patients who had received only 1-2 previous treatments showed significantly lower recurrence rates than patients with > or =3 treatments (9% vs. 37%, P = 0.0411). In conclusion, LDLT may constitute an optional treatment with a chance of cure for patients with otherwise uncontrolled disease. However, repeated nontransplant treatments for recurrent HCC prior to LDLT may increase the risk of recurrence and impair the survival advantages conferred by LDLT.
活体供肝肝移植（LDLT）已发展成为肝细胞癌（HCC）患者的一项重要手术策略。然而，由于存在包括供体风险和围手术期并发症发生率较高等缺点，在日本LDLT一直被视为二线治疗方法。本研究回顾性评估了在我院接受LDLT的93例HCC患者的临床结局，其中包括44例超过米兰标准（MC）的患者。共有73例患者（78%）有使用各种非移植方法治疗HCC的既往史。中位随访时间为24个月（范围1 - 76个月）。LDLT术后4年，患者总体生存率为64%，MC内和MC外组的生存率相似（分别为68%和59%；P = 0.6548）。然而，MC外组的累积复发率显著高于MC内组（35%对15%，P = 0.0190）。关于LDLT前HCC的传统治疗史，仅接受过1 - 2次既往治疗的患者复发率显著低于接受过≥3次治疗的患者（9%对37%，P = 0.0411）。总之，LDLT可能是一种对其他治疗无法控制的疾病患者有治愈机会的可选治疗方法。然而，LDLT前对复发性HCC进行反复非移植治疗可能会增加复发风险，并削弱LDLT带来的生存优势。
