Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
Hepatobiliary Pancreat Dis Int. 2010 Aug;9(4):366-9.
Liver transplantation (LT) has been widely accepted as the treatment of choice for end-stage liver diseases. Due to the scarcity of cadaveric donors, adult-to-adult living donor liver transplantation (LDLT) is advocated as a practical alternative to deceased donor liver transplantation (DDLT). However, some reports suggest that the long-term and recurrence-free survival rates of LDLT are poorer than those of DDLT for hepatocellular carcinoma (HCC). This study aimed to compare the long-term and recurrence-free survival rates of HCC between LDLT and DDLT.
We retrospectively analyzed the clinical data of 150 patients with HCC from January 2005 to March 2009. Eleven patients who died of complications during the perioperative period were excluded. The remaining 139 eligible patients (101 DDLT and 38 LDLT) were regularly followed up to October 2009. The Chi-square test or Fisher's exact test were used to compare the characteristics of LDLT and DDLT. The long-term and recurrence-free survival curves of both groups were determined using the Kaplan-Meier method with comparisons performed using the log-rank test. One-way analysis of variance was performed to compare the waiting time of the two groups.
Survival rates at 1, 2, 3, and 4 years for LDLT were 81%, 62%, 53%, and 45% and for DDLT were 86%, 60%, 50%, and 38%, respectively. The overall 1-, 2-, 3-, and 4-year recurrence-free rates for LDLT were 71%, 49%, 42%, and 38%, and for DDLT were 76%, 52%, 41%, and 37%, respectively. No significant differences were found by the log-rank test on both long-term and recurrence-free survival rates.
The role of LDLT is reinforced by our study. It may expand the donor pool and achieve the same long-term and recurrence-free survival rates of DDLT.
肝移植（LT）已被广泛认为是治疗终末期肝病的首选方法。由于尸体供体的稀缺，成人对成人活体肝移植（LDLT）被提倡作为对已故供体肝移植（DDLT）的实际替代方案。然而，一些报告表明，LDLT 的肝癌（HCC）患者的长期和无复发生存率不如 DDLT。本研究旨在比较 LDLT 和 DDLT 治疗 HCC 的长期和无复发生存率。
我们回顾性分析了 2005 年 1 月至 2009 年 3 月间 150 例 HCC 患者的临床资料。排除了 11 例围手术期因并发症死亡的患者。其余 139 例符合条件的患者（101 例 DDLT 和 38 例 LDLT）于 2009 年 10 月前定期随访。采用卡方检验或 Fisher 精确检验比较 LDLT 和 DDLT 的特征。采用 Kaplan-Meier 法计算两组的长期和无复发生存曲线，采用对数秩检验进行比较。采用单因素方差分析比较两组的等待时间。
LDLT 的 1、2、3 和 4 年生存率分别为 81%、62%、53%和 45%，DDLT 分别为 86%、60%、50%和 38%。LDLT 的总体 1、2、3 和 4 年无复发生存率分别为 71%、49%、42%和 38%，DDLT 分别为 76%、52%、41%和 37%。对数秩检验在长期和无复发生存率上均无显著性差异。
本研究强化了 LDLT 的作用。它可能扩大供体库，并达到与 DDLT 相同的长期和无复发生存率。
