Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Liver Transpl. 2012 Oct;18(10):1226-36. doi: 10.1002/lt.23490.
Because of the severe organ shortage, living donor liver transplantation (LDLT) offers a timely alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, the higher recurrence rate of HCC after LDLT and the indication criteria remain controversial. By conducting a quantitative meta-analysis, we sought to compare the survival outcomes and recurrence rates with LDLT and DDLT for patients with HCC. Comparative studies of LDLT and DDLT for HCC, which were identified by a comprehensive literature search, were included in this study. The evaluated outcomes included patient survival, recurrence-free survival (RFS), and recurrence rates at defined time points. Seven studies with a total of 1310 participants were included in this study. For LDLT and DDLT recipients, we found comparable patient survival rates [1 year, odds ratio (OR) = 1.03, 95% confidence interval (CI) = 0.62-1.73; 3 years, OR = 1.07, 95% CI = 0.77-1.48; and 5 years, OR = 0.64, 95% CI = 0.33-1.24] and RFS rates (1 year, OR = 0.86, 95% CI = 0.54-1.38; 3 years, OR = 1.04, 95% CI = 0.69-1.58; and 5 years, OR = 1.11, 95% CI = 0.70-1.77). Moreover, we found no significant differences in the 1-, 3-, or 5-year recurrence rates between LDLT and DDLT recipients (1 year, OR = 1.55, 95% CI = 0.36-6.58; 3 years, OR = 2.57, 95% CI = 0.53-12.41; and 5 years, OR = 1.21, 95% CI = 0.44-3.32). A subgroup analysis revealed similar outcomes for patients with HCC meeting the Milan criteria. These findings demonstrate that for HCC patients (especially those within the Milan criteria), LDLT represents an acceptable option that does not compromise patient survival or increase HCC recurrence in comparison with DDLT.
由于严重的器官短缺，活体供肝移植 (LDLT) 为肝细胞癌 (HCC) 患者提供了及时的替代方案，而不是已故供肝移植 (DDLT)。然而，LDLT 后 HCC 的复发率较高，且其适应证标准仍存在争议。通过进行定量荟萃分析，我们旨在比较 LDLT 和 DDLT 治疗 HCC 患者的生存结果和复发率。通过全面的文献检索，对 LDLT 和 DDLT 治疗 HCC 的对照研究进行了评估。本研究纳入了 7 项研究，共 1310 名参与者。对于 LDLT 和 DDLT 受者，我们发现患者生存率相似[1 年，比值比 (OR) = 1.03，95%置信区间 (CI) = 0.62-1.73；3 年，OR = 1.07，95%CI = 0.77-1.48；5 年，OR = 0.64，95%CI = 0.33-1.24]和无复发生存率相似 (1 年，OR = 0.86，95%CI = 0.54-1.38；3 年，OR = 1.04，95%CI = 0.69-1.58；5 年，OR = 1.11，95%CI = 0.70-1.77)。此外，我们发现 LDLT 和 DDLT 受者在 1、3 或 5 年的复发率之间没有显著差异 (1 年，OR = 1.55，95%CI = 0.36-6.58；3 年，OR = 2.57，95%CI = 0.53-12.41；5 年，OR = 1.21，95%CI = 0.44-3.32)。亚组分析显示，符合米兰标准的 HCC 患者也有类似的结果。这些发现表明，对于 HCC 患者(特别是符合米兰标准的患者)，LDLT 是一种可以接受的选择，与 DDLT 相比，不会影响患者的生存率或增加 HCC 的复发率。
