Department of Medicine and Surgery, Northwestern University, Chicago, IL, USA.
Am J Transplant. 2012 Nov;12(11):2997-3007. doi: 10.1111/j.1600-6143.2012.04272.x. Epub 2012 Sep 20.
Hepatocellular carcinoma (HCC) represents an increasing fraction of liver transplant indications; the role of living donor liver transplant (LDLT) remains unclear. In the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, patients with HCC and an LDLT or deceased donor liver transplant (DDLT) for which at least one potential living donor had been evaluated were compared for recurrence and posttransplant mortality rates. Mortality from date of evaluation of each recipient's first potential living donor was also analyzed. Unadjusted 5-year HCC recurrence was significantly higher after LDLT (38%) than DDLT (11%), (p = 0.0004). After adjustment for tumor characteristics, HCC recurrence remained significantly different between LDLT and DDLT recipients (hazard ratio (HR) = 2.35; p = 0.04) for the overall cohort but not for recipients transplanted following the introduction of MELD prioritization. Five-year posttransplant survival was similar in LDLT and DDLT recipients from time of transplant (HR = 1.32; p = 0.27) and from date of LDLT evaluation (HR = 0.73; p = 0.36). We conclude that the higher recurrence observed after LDLT is likely due to differences in tumor characteristics, pretransplant HCC management and waiting time.
肝细胞癌 (HCC) 在肝移植适应证中占比不断增加；活体肝移植 (LDLT) 的作用仍不明确。在成人对成人活体肝移植队列研究中，比较了 HCC 患者接受 LDLT 或已故供体肝移植 (DDLT) 的情况，评估了复发率和移植后死亡率。还分析了每位受者首位潜在活体供者评估日期的死亡率。未调整的 5 年 HCC 复发率，LDLT 后明显高于 DDLT（38% vs. 11%，p = 0.0004）。在调整肿瘤特征后，LDLT 和 DDLT 受者的 HCC 复发率仍有显著差异（风险比 (HR) = 2.35；p = 0.04），但 MELD 优先排序引入后移植受者除外。从移植时（HR = 1.32；p = 0.27）和 LDLT 评估时（HR = 0.73；p = 0.36）的时间来看，LDLT 和 DDLT 受者的 5 年移植后生存率相似。我们的结论是，LDLT 后观察到的较高复发率可能归因于肿瘤特征、移植前 HCC 管理和等待时间的差异。
