Department of Liver and Vascular Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2012 May 21;18(19):2415-22. doi: 10.3748/wjg.v18.i19.2415.
To evaluate survival and recurrence after salvage liver transplantation (SLT) for the treatment of hepatocellular carcinoma (HCC) compared with primary liver transplantation (PLT) using a meta-analysis.
Literature on SLT versus PLT for the treatment of HCC published between 1966 and July 2011 was retrieved. A meta-analysis was conducted to estimate pooled survival and disease-free rates. A fixed or random-effect model was established to collect the data.
The differences in overall survival and disease-free survival rates at 1-year, 3-year and 5-year survival rates were not statistically significant between SLT group and PLT group (P > 0.05). After stratifying the various studies by donor source and Milan criteria, we found that: (1) Living donor liver transplantation recipients had significantly higher 1-year survival rate, lower 3-year and 5-year survival rates compared with deceased-donor liver transplantation (DDLT) recipients. And in DDLT recipients they had better 1-year and 5-year disease-free survival rate in SLT group; and (2) No difference was seen in 1-year, 3-year and 5-year survival rates between two groups who beyond Milan criteria at the time of liver transplantation.
SLT can be effectively performed for patients with recurrence or deterioration of liver function after hepatectomy for HCC. It does not increase the perioperative mortality and has a similar long-term survival rates compared to PLT.
通过荟萃分析评估肝移植治疗肝细胞癌（HCC）后行挽救性肝移植（SLT）与原发性肝移植（PLT）的存活率和复发率。
检索了 1966 年至 2011 年 7 月期间发表的关于 SLT 与 PLT 治疗 HCC 的文献。采用荟萃分析来评估总体生存率和无疾病生存率。采用固定或随机效应模型来收集数据。
在 1 年、3 年和 5 年生存率方面，SLT 组与 PLT 组之间的总生存率和无疾病生存率差异无统计学意义（P > 0.05）。通过对供体来源和米兰标准进行分层研究后，我们发现：（1）活体供体肝移植受者的 1 年生存率明显较高，3 年和 5 年生存率明显较低，而死亡供体肝移植（DDLT）受者的 5 年生存率明显较高；并且在 DDLT 受者中，SLT 组的 1 年和 5 年无疾病生存率更高；（2）在肝移植时超出米兰标准的两组患者，1 年、3 年和 5 年生存率无差异。
对于因 HCC 行肝切除术后出现肝功能恶化或复发的患者，可有效地行 SLT。它不会增加围手术期死亡率，并且与 PLT 相比，其长期生存率相似。
