Confer B D, Choudhary M, Lopez R, Zein N N
Departments of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, United States.
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States.
Transplant Proc. 2015 Jan-Feb;47(1):217-22. doi: 10.1016/j.transproceed.2014.10.044.
After liver transplant (LT), the risk of hepatocellular carcinoma (HCC) recurrence is partially dependent on the degree of immunosuppression. We aimed to determine whether assessing net state of CD4(+) T-cell function after LT could determine those at risk for HCC recurrence.
One hundred thirty-seven patients with cirrhosis who underwent LT for HCC were followed for recurrence of HCC. All patients had serial CD4(+) assay performed prospectively. Cox regression analysis was used to assess factors associated with HCC recurrence. Kaplan-Meier plots were used to assess the association between CD4(+) ATP values and hazard of HCC recurrence.
The mean follow-up time was 3.1 ± 1.5 years, during which 14 patients (10%) had HCC recurrence. Patients with combined post-LT CD4(+) T-cell function area under curve (AUC) <675 had 6.9 (95% CI 2.0-22.0) times greater hazard of HCC recurrence than those with CD4(+) T-cell function AUC ≥675 (P < .001). Less immunosuppression (ATP AUC ≥675) in those beyond Milan conferred a similar risk of recurrence as patients transplanted within Milan (P = .064).
Lower cumulative CD4(+) T-cell function post-LT predicted a higher risk of HCC recurrence. These findings may have implications toward management of HCC patients after LT.
肝移植（LT）后，肝细胞癌（HCC）复发风险部分取决于免疫抑制程度。我们旨在确定评估LT后CD4(+) T细胞功能的净状态是否能确定HCC复发风险患者。
对137例因HCC接受LT的肝硬化患者进行HCC复发随访。所有患者均前瞻性地进行了系列CD4(+)检测。采用Cox回归分析评估与HCC复发相关的因素。使用Kaplan-Meier曲线评估CD4(+) ATP值与HCC复发风险之间的关联。
平均随访时间为3.1±1.5年，在此期间14例患者（10%）出现HCC复发。LT后CD4(+) T细胞功能曲线下面积（AUC）<675的患者HCC复发风险比CD4(+) T细胞功能AUC≥675的患者高6.9倍（95%CI 2.0 - 22.0）（P <.001）。米兰标准以外患者免疫抑制较低（ATP AUC≥675）时的复发风险与米兰标准以内移植患者相似（P = 0.064）。
LT后累积CD4(+) T细胞功能较低预示HCC复发风险较高。这些发现可能对LT后HCC患者的管理有影响。
