Lo C M, Fan S T, Liu C L, Chan S C, Ng I O-L, Wong J
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Br J Surg. 2007 Jan;94(1):78-86. doi: 10.1002/bjs.5528.
Hypothetical studies that favour living donor liver transplantation (LDLT) for early hepatocellular carcinoma (HCC) assumed a comparable outcome after LDLT and deceased donor liver transplantation (DDLT). The aim of this study was to compare the outcome after LDLT with that after DDLT, and to identify factors that might account for any differences.
The study included 60 patients who met the radiological Milan or University of California at San Francisco (UCSF) criteria and underwent LDLT (43 patients) or DDLT (17).
The LDLT group had fewer incidental tumours and a lower rate of pretransplant transarterial chemoembolization but a higher rate of salvage transplantation. Waiting time was shorter and graft weight to standard liver weight (GW : SLW) ratio was lower in this group. The perioperative course, and histopathological tumour size, number, grade and stage were comparable. Median follow-up was 33 (range 4-120) months. The cumulative 5-year recurrence rate was 29 per cent in the LDLT group and 0 per cent in the DDLT group (P = 0.029). A GW : SLW ratio of 0.6 or less, salvage transplantation, three or more tumour nodules, microscopic vascular invasion, and pathological stage beyond the Milan or UCSF criteria were significant confounding risk factors. Multivariable analysis identified salvage transplantation (relative risk 5.16 (95 per cent confidence interval (c.i.) 1.48 to 18.02); P = 0.010) and pathological stage beyond the UCSF criteria (relative risk 4.10 (95 per cent c.i. 1.02 to 16.48); P = 0.047) as independent predictors of recurrence.
Despite standard radiological selection criteria based on number and size, patients who underwent LDLT for HCC had more recurrence because of selection bias for other clinical characteristics.
支持活体肝移植（LDLT）用于早期肝细胞癌（HCC）的假设性研究认为，LDLT和尸体供肝肝移植（DDLT）后的结果相当。本研究的目的是比较LDLT和DDLT后的结果，并确定可能导致差异的因素。
本研究纳入了60例符合米兰或加州大学旧金山分校（UCSF）影像学标准并接受LDLT（43例患者）或DDLT（17例患者）的患者。
LDLT组的意外肿瘤较少，移植前经动脉化疗栓塞率较低，但挽救性移植率较高。该组等待时间较短，移植物重量与标准肝脏重量（GW：SLW）之比较低。围手术期过程以及组织病理学肿瘤大小、数量、分级和分期相当。中位随访时间为33（4-120）个月。LDLT组的5年累积复发率为29%，DDLT组为0%（P=0.029）。GW：SLW比为0.6或更低、挽救性移植、三个或更多肿瘤结节、微血管侵犯以及超出米兰或UCSF标准的病理分期是显著的混杂危险因素。多变量分析确定挽救性移植（相对风险5.16（95%置信区间（c.i.）1.48至18.02）；P=0.010）和超出UCSF标准的病理分期（相对风险4.10（95% c.i. 1.02至16.48）；P=0.047）是复发的独立预测因素。
尽管基于数量和大小的标准影像学选择标准，但因其他临床特征的选择偏倚，接受LDLT治疗HCC的患者复发更多。
