Sotiropoulos G C, Tagkalos E, Fouzas I, Vernadakis S, Mathé Z, Treckmann J, Paul A
Department of General, Visceral and Transplantation Surgery, University Hosiptal Essen, Essen, Germany.
Transplant Proc. 2012 Nov;44(9):2730-3. doi: 10.1016/j.transproceed.2012.09.021.
Liver transplantation (OLT) represents the treatment of choice for small hepatocellular carcinomas (HCC) in patients with end-stage liver disease. However, because of organ scarcity, alternative options must be explored, such as the use of extended criteria donor (ECD) grafts.
We reviewed data of transplanted HCC patients using ECD grafts. Statistical analysis included uni- and multivariate Cox proportional hazards regression and survival analysis using the Kaplan-Meier method with the log-rank test.
Over a 6-year period, we transplanted 53 HCC patients with ECD grafts. The 38 men and 15 women showed a mean age of 56.3 ± 8.26 years. Thirty-four patients underwent a bridging treatment before OLT. Thirty-eight patients (72%) were outside the Milan criteria. The median value for alpha fetoprotein (AFP) level was 30.7 ng/dL. Pathologic tumor grade was G1 (n = 4), G2 (n = 32), G3 (n = 6), or Gx (n = 11). Median follow-up time was 23 months (range, 9-75). Overall 3- and 5- year patient survivals were 79% and 74%, respectively. The 5-year survivals for patients within or outside the Milan criteria were 87% versus 69%, respectively (P = .3728). Donor transaminases and post-OLT hemodialysis were prognostic factors for patient survival upon mutivariate regression analysis (P = .0043 and P = .0003, respectively).
OLT with ECD grafts constitutes an additional option for patients with HCC and cirrhosis, particularly subjects outside the Milan criteria. The risk- benefit ratio in these instances should be evaluated on a case-by-case basis.
肝移植(OLT)是终末期肝病患者小肝细胞癌(HCC)的首选治疗方法。然而,由于器官短缺,必须探索其他选择,例如使用扩大标准供体(ECD)移植物。
我们回顾了使用ECD移植物的HCC移植患者的数据。统计分析包括单因素和多因素Cox比例风险回归以及使用Kaplan-Meier方法和对数秩检验的生存分析。
在6年期间,我们为53例HCC患者移植了ECD移植物。38名男性和15名女性的平均年龄为56.3±8.26岁。34例患者在OLT前接受了桥接治疗。38例患者(72%)不符合米兰标准。甲胎蛋白(AFP)水平的中位数为30.7 ng/dL。病理肿瘤分级为G1(n = 4)、G2(n = 32)、G3(n = 6)或Gx(n = 11)。中位随访时间为23个月(范围9 - 75个月)。总体3年和5年患者生存率分别为79%和74%。符合或不符合米兰标准的患者5年生存率分别为87%和69%(P = 0.3728)。多因素回归分析显示,供体转氨酶和OLT后血液透析是患者生存的预后因素(分别为P = 0.0043和P = 0.0003)。
使用ECD移植物进行OLT是HCC和肝硬化患者的另一种选择,尤其是不符合米兰标准的患者。在这些情况下,应逐案评估风险效益比。