Transplant Center of Excellence, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA.
Langenbecks Arch Surg. 2012 Jun;397(5):711-5. doi: 10.1007/s00423-012-0910-3. Epub 2012 Jan 28.
In this study, we ask between patients with graft failure listed for retransplant and patients with hepatocellular carcinoma (HCC) outside of UCSF criteria, who has the greater survival benefit with transplantation?
This is a retrospective analysis, of liver transplant (LT) patients, done between February 2002 and December 2009 at our center. Patients were included in the "extended HCC" group if their tumor was pathologically beyond UCSF criteria at LT and in the "redo" group if they underwent LT for graft failure occurring more than 3 months after the initial LT. Extended criteria donors (ECDs) were defined as donors above 70 years old, DCD, serology positive for HCV, and split grafts.
There were 25 redos and 37 extended HCC patients. Use of ECDs or high donor risk index organs was associated with poor outcome in both groups (P = 0.005). Overall, the extended HCC population had a much better survival than redos, both at 1 and 3 years.
These two very different but high risk patient populations have very different survival rates. At a time where regulatory agencies demand more and more with regards to transplant outcomes, we think the transplant community has to reflect on whether allocation justice and fair access to transplant are respected if we start allocating organs based on outcomes.
在这项研究中，我们比较了移植名单中移植失败的患者和 UCSF 标准之外的肝细胞癌（HCC）患者，谁从移植中获益更大？
这是一项回顾性分析，纳入了 2002 年 2 月至 2009 年 12 月在我们中心接受肝移植（LT）的患者。如果患者在 LT 时肿瘤的病理超出了 UCSF 标准，则将其纳入“扩展 HCC”组；如果患者因初始 LT 后 3 个月以上发生移植物衰竭而行 LT，则将其纳入“再移植”组。扩展标准供体（ECD）定义为年龄超过 70 岁、DCD、HCV 血清学阳性和分体供体。
有 25 例再移植和 37 例扩展 HCC 患者。在两组中，使用 ECD 或高供体风险指数器官与不良结局相关（P = 0.005）。总体而言，扩展 HCC 人群的 1 年和 3 年生存率均明显高于再移植人群。
这两个非常不同但风险很高的患者群体的生存率有很大差异。在监管机构对移植结果的要求越来越高的情况下，我们认为，如果我们开始根据结果分配器官，移植界必须反思在尊重分配公正和公平获得移植的情况下，是否尊重分配正义和公平获得移植。
