Salvalaggio P R, Felga G, Axelrod D A, Della Guardia B, Almeida M D, Rezende M B
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Am J Transplant. 2015 Mar;15(3):668-77. doi: 10.1111/ajt.13011. Epub 2015 Feb 3.
The time that patients with hepatocellular carcinoma (HCC) can safely remain on the waiting list for liver transplantation (LT) is unknown. We investigated whether waiting time on the list impacts transplant survival of HCC candidates and transplant recipients. This is a single-center retrospective study of 283 adults with HCC. Patients were divided in groups according to waiting-list time. The main endpoint was survival. The median waiting time for LT was 4.9 months. The dropout rates at 3-, 6-, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Mortality on the list was 4.8%, but varied depending of the time on the list. Patients who waited less than 3-months had an inferior overall survival when compared to the other groups (p = 0.027). Prolonged time on the list significantly reduced mortality in this analysis (p = 0.02, HR = 0.28). Model for End Stage Liver Disease (MELD) score at transplantation did also independently impact overall survival (p = 0.03, HR = 1.06). MELD was the only factor that independently impacted posttransplant survival (p = 0.048, HR = 1.05). We conclude that waiting time had no relation with posttransplant survival. It is beneficial to prolong the waiting list time for HCC candidates without having a negative impact in posttransplant survival.
肝细胞癌（HCC）患者能够安全地留在肝移植（LT）等待名单上的时间尚不清楚。我们调查了等待名单上的时间是否会影响HCC候选者和移植受者的移植存活率。这是一项针对283例成年HCC患者的单中心回顾性研究。患者根据在等待名单上的时间分组。主要终点是存活率。LT的中位等待时间为4.9个月。3个月、6个月和12个月时的退出率分别为6.4%、12.4%和17.7%。等待名单上的死亡率为4.8%，但因在等待名单上的时间而异。与其他组相比，等待时间少于3个月的患者总存活率较低（p = 0.027）。在此分析中，延长等待名单上的时间显著降低了死亡率（p = 0.02，HR = 0.28）。移植时的终末期肝病模型（MELD）评分也独立影响总存活率（p = 0.03，HR = 1.06）。MELD是唯一独立影响移植后存活率的因素（p = 0.048，HR = 1.05）。我们得出结论，等待时间与移植后存活率无关。延长HCC候选者的等待名单时间是有益的，且不会对移植后存活率产生负面影响。
