Department of Transplantation, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
Liver Transpl. 2009 Dec;15(12):1861-6. doi: 10.1002/lt.21940.
In regions with a limited deceased donor pool, living donor adult liver transplantation (LDALT) has become an important treatment modality for patients with hepatocellular carcinoma (HCC) and cirrhosis. Studies have shown higher recurrence rates of HCC after LDALT in comparison with deceased donor liver transplantation (DDLT). The aim of our study was to examine the outcome results and recurrence rates for patients with HCC who underwent LDALT at our center. During an 8-year period, 139 patients underwent LDALT, of whom 28 (20.1%) had HCC in their explanted livers. The median follow-up was 40.8 months. The mean explant tumor size was 3.3 +/- 1.2, and the mean number of tumors was 1.5 +/- 0.8. Twenty-one patients (75%) had tumors within the Milan criteria, 5 patients had tumors outside the Milan criteria but within the University of California San Francisco (UCSF) criteria, and 2 patients were beyond the UCSF criteria. The overall 1- and 5-year patient and graft survival rates were 96% and 81%, respectively. Survival following LDALT was significantly better than survival following DDLT for HCC during the same time period (P = 0.02). Eight patients (28.6%) developed tumor recurrence. Poor differentiation of tumor cells was the most significant determinant of recurrence. Despite high recurrence rates of HCC following LDALT, overall 5-year survival appears to be excellent.
在供体有限的地区，活体供体成人肝移植（LDALT）已成为治疗肝细胞癌（HCC）和肝硬化患者的重要手段。研究表明，与尸体供肝移植（DDLT）相比，LDALT 后 HCC 的复发率更高。我们的研究旨在检查在我们中心接受 LDALT 的 HCC 患者的结果和复发率。在 8 年期间，有 139 名患者接受了 LDALT，其中 28 名（20.1%）的供肝中有 HCC。中位随访时间为 40.8 个月。平均移植肝肿瘤大小为 3.3 +/- 1.2，平均肿瘤数量为 1.5 +/- 0.8。21 名患者（75%）的肿瘤符合米兰标准，5 名患者的肿瘤不符合米兰标准但符合加利福尼亚大学旧金山分校（UCSF）标准，2 名患者超出了 UCSF 标准。总的 1 年和 5 年患者和移植物存活率分别为 96%和 81%。在同一时期，LDALT 后的生存率明显优于 DDLT 后的生存率（P = 0.02）。8 名患者（28.6%）发生肿瘤复发。肿瘤细胞分化不良是复发的最显著决定因素。尽管 LDALT 后 HCC 的复发率较高，但总体 5 年生存率似乎很好。
