Vivanco M, Gabrielli M, Jarufe N, Humeres R, Rios H, Palacios J M, Zapata R, Sanhueza E, Contreras J, Rencore G, Rossi R, Martínez J, Pérez R, Guerra J, Arrese M, Figueroa E, Soza A, Yáñes R, Hepp J
Liver Transplantation Program, Clínica Alemana, Santiago, Chile.
Transplant Proc. 2010 Jan-Feb;42(1):296-8. doi: 10.1016/j.transproceed.2009.11.019.
Orthotopic liver transplantation (OLT) is currently an established therapy for small, early-stage hepatocellular carcinoma (HCC) within the Milan criteria. Long waiting times due to the shortage of donor organs can result in tumor progression and drop-out from OLT candidacy. Therefore a wide variety of procedures are necessary before OLT. The aim of this retrospective study was to review our experience in relation to bridge therapy prior to OLT for HCC.
This was a retrospective database review of all of the patient who underwent transplantation in our institutions between January 1993 and June 2009. We analyzed patients with a diagnosis of HCC in the explant.
Among 29 patients, including 12 who were diagnosed by the explant and 17 prior to transplantation, 88% underwent bridge therapy during a mean waiting time to OLT of 12 months. Among the 23 procedures, namely 1.5 procedures per patient, included most frequently chemoembolization (48%), alcohol ablation (30%), radiofrequency ablation (13%), and surgery (9%). Thirty-three percent of the explants contained lesions within the Milan criteria. In our series the 5-year survival rate for patients transplanted for HCC was 86%; in the bridge therapy group, it was 73%.
The incidence of patients who underwent bridge therapy (52%) was similar to other reported experiences, but the fulfillment of Milan criteria in the explants was lower. Among the bridge therapy group, the survival was slightly lower, probably because this group displayed more advanced disease.
原位肝移植（OLT）目前是治疗符合米兰标准的小肝癌及早期肝癌的既定疗法。供体器官短缺导致的长时间等待会致使肿瘤进展以及患者退出OLT候选名单。因此，在进行OLT之前需要采取多种治疗手段。本回顾性研究的目的是回顾我们在肝癌OLT术前桥接治疗方面的经验。
这是一项对1993年1月至2009年6月期间在我们机构接受移植的所有患者的回顾性数据库研究。我们分析了移植肝中诊断为肝癌的患者。
29例患者中，包括12例经移植肝诊断出的患者和17例移植前诊断出的患者，88%在平均等待OLT的12个月期间接受了桥接治疗。在23种治疗手段中，即每位患者平均1.5种，最常见的是化疗栓塞（48%）、酒精消融（30%）、射频消融（13%）和手术（9%）。33%的移植肝中含有符合米兰标准的病灶。在我们的研究系列中，肝癌移植患者的5年生存率为86%；在桥接治疗组中，这一比例为73%。
接受桥接治疗的患者比例（52%）与其他报道的经验相似，但移植肝中符合米兰标准的比例较低。在桥接治疗组中，生存率略低，可能是因为该组疾病进展更严重。
