Di Sandro Stefano, Giacomoni Alessandro, Slim Abdallah, Lauterio Andrea, Mangoni Iacopo, Mihaylov Plamen, Pirotta Vincenzo, Aseni Paolo, De Carlis Luciano
Department of General Surgery and Transplantation, Niguarda Ca'Granda Hospital, Milan, Italy.
Hepatogastroenterology. 2012 Mar-Apr;59(114):505-10. doi: 10.5754/hge11225.
BACKGROUND/AIMS: LDLT may represent a valid therapeutic option allowing several advantages for patients affected by HCC and waiting for liver transplantation (LT). However, some reports show a worse long term survival and disease free survival among patients treated by LDLT for HCC than deceased donor liver transplantation (DDLT) recipients.
Among 1145 LT patients, 63 received LDLT. From January 2000 to December 2008, 179 patients underwent LT due to HCC, 30 (16.7%) received LDLT and 154 (86.0%) received DDLT. Patients were selected based on the Milan criteria. TACE, radiofrequency ablation, percutaneous alcoholization, or liver resection were applied as downstaging procedures, while on the waiting list.
Overall 3- and 5-year survival rate was 77.3% and 68.7% vs. 82.8% and 76.7%, respectively for LDLT and DDLT recipient with not significant differences. Moreover, 3- and 5- years of recurrence free survival rate was 95.5% (LDLT) vs. 90.5% and 89.4% (DDLT) and resulted not significantly different.
LDLT guarantees same long term results than DDLT if the selection criteria of candidates are analogues. Milan criteria remains a valid candidate selection tool to obtain optimal long term results in LDLT. An aggressive downstaging policy seems to improve the long-term results in LDLT, thus LRT may be considered useful to prevent tumor progression waiting for transplantation as well as a neoadjuvant therapy for HCC. A literature detailed meta-analysis could definitely clarify if LDLT is an independent risk factor for HCC recurrence.
背景/目的：活体肝移植（LDLT）可能是一种有效的治疗选择，对肝癌患者等待肝移植（LT）具有诸多优势。然而，一些报告显示，与尸体供肝肝移植（DDLT）受者相比，接受LDLT治疗的肝癌患者长期生存率和无病生存率较差。
在1145例LT患者中，63例接受了LDLT。从2000年1月至2008年12月，179例因肝癌接受LT，其中30例（16.7%）接受LDLT，154例（86.0%）接受DDLT。患者根据米兰标准进行选择。在等待名单上时，采用经动脉化疗栓塞（TACE）、射频消融、经皮乙醇注射或肝切除术作为降期治疗手段。
总体而言，LDLT受者和DDLT受者的3年和5年生存率分别为77.3%和68.7%，以及82.8%和76.7%，差异无统计学意义。此外，LDLT的3年和5年无复发生存率分别为95.5%，而DDLT为90.5%和89.4%，差异无统计学意义。
如果候选者的选择标准相似，LDLT可保证与DDLT相同的长期效果。米兰标准仍然是在LDLT中获得最佳长期效果的有效候选者选择工具。积极的降期策略似乎可改善LDLT的长期效果，因此LRT可被视为在等待移植期间预防肿瘤进展以及作为肝癌新辅助治疗的有用方法。一项详细的文献荟萃分析肯定可以阐明LDLT是否是肝癌复发的独立危险因素。
