Kumaran Vinay
Liver Transplant and HPB Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra 400053, India.
J Clin Exp Hepatol. 2014 Aug;4(Suppl 3):S97-S103. doi: 10.1016/j.jceh.2014.01.002. Epub 2014 Jan 23.
This review evaluates the available evidence to establish the role of liver transplantation in the management of hepatocellular carcinoma in India. Most liver transplants in India are living donor transplants due to the paucity of brain dead organ donors. There is sufficient evidence to permit allocation of organs to patients with tumors within the Milan criteria. If the waiting list time is more than 6 months, a down-staging locoregional treatment modality such a trans-arterial chemoembolization, radiofrequency ablation, resection or percutaneous ethanol injection may be used to prevent disease progression. Allocating scarce livers to patients with more advanced tumors may not be justifiable. However, living donor liver transplantation may be offered to medically fit patients with hepatocellular carcinoma with cirrhosis, offering a guarded prognosis to patients beyond the Milan or UCSF criteria. Vascular invasion and extra-hepatic disease should be absolute contraindications to liver transplantation.
本综述评估了现有证据，以确定肝移植在印度肝细胞癌管理中的作用。由于脑死亡器官供体匮乏，印度的大多数肝移植是活体供体移植。有充分证据允许将器官分配给符合米兰标准的肿瘤患者。如果等待名单时间超过6个月，可采用诸如经动脉化疗栓塞、射频消融、切除或经皮乙醇注射等降期局部区域治疗方式来预防疾病进展。将稀缺的肝脏分配给肿瘤更晚期的患者可能不合理。然而，对于患有肝硬化的肝细胞癌且身体状况适合的患者，可以提供活体供体肝移植，对于超出米兰或加州大学旧金山分校标准的患者，预后不佳。血管侵犯和肝外疾病应绝对禁止肝移植。
