Division of Transplant Surgery, Rhode Island Hospital, Providence, RI 02903, USA.
HPB (Oxford). 2008;10(6):412-5. doi: 10.1080/13651820802392320.
This study aimed to assess the impact of wait times on patient survival following liver transplantation for hepatocellular carcinoma (HCC) in a single donor service area.
Patients listed in the New England Organ Bank (NEOB) from 1996 to 2005 for liver transplantation with a diagnosis of HCC were identified from the United Network for Organ Sharing database. The following data were extracted: date of listing, date removed from the wait list, indication for wait list removal, patient death and date of last known follow-up. Kaplan-Meier survival estimates were calculated from the time of listing for transplant (intention to treat liver transplant survival, ITT OLT) and compared to those calculated from the date of transplant (liver transplant, OLT).
There were 63 new registrations to the transplant list during the study period. Sixty-one patients were removed from the waiting list: transplanted 41 (65%), death seven (11%), candidate condition deteriorated/too sick to transplant eight (13%), medically unsuitable one (2%), other one (2%), transferred to another center two (3%), and transplanted at another center one (2%). Three-year survival following liver transplantation for primary liver cancer was 85%. When the results were analyzed using an intention to treat analysis there was a 10-20% decrease in survival rate at every time point due to wait list drop-out.
Wait list drop-out adversely affects liver transplant survival in transplant centers served by the NEOB. These data should be considered when recommending transplant versus resection as first line therapy for stage I or II HCC in our region.
本研究旨在评估在单一供体服务区，肝癌（HCC）患者接受肝移植时等待时间对患者生存的影响。
从 1996 年至 2005 年，从新英格兰器官银行（NEOB）列出的肝移植患者中，通过器官共享联合网络数据库确定了 HCC 诊断患者。提取以下数据：列入名单日期、从等待名单中删除日期、等待名单删除原因、患者死亡日期和最后一次已知随访日期。从移植（意向性肝移植生存，ITT OLT）时间计算移植列表中患者的 Kaplan-Meier 生存估计，并与从移植日期（肝移植，OLT）计算的生存估计进行比较。
研究期间，有 63 名新患者登记加入移植名单。61 名患者从等待名单中移除：移植 41 例（65%），死亡 7 例（11%），候选者病情恶化/太虚弱无法移植 8 例（13%），医学上不适合 1 例（2%），其他原因 1 例（2%），转移到另一个中心 2 例（3%），在另一个中心移植 1 例（2%）。原发性肝癌肝移植后 3 年生存率为 85%。当使用意向治疗分析进行分析时，由于等待名单的淘汰，每个时间点的生存率下降了 10-20%。
等待名单淘汰对 NEOB 服务的移植中心的肝移植生存率有不利影响。在我们地区，当推荐将肝移植与切除术作为 I 期或 II 期 HCC 的一线治疗时，应考虑这些数据。
