Guerrero-Misas Marta, Rodríguez-Perálvarez Manuel, De la Mata Manuel
Marta Guerrero-Misas, Manuel Rodríguez-Perálvarez, Manuel De la Mata, Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, Maimónides Institute of Biomedical Research of Córdoba, CIBERehd, 14004 Córdoba, Spain.
World J Hepatol. 2015 Apr 8;7(4):649-61. doi: 10.4254/wjh.v7.i4.649.
Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. Indeed, liver transplantation is considered the standard of care for a subset of patients with cirrhosis and hepatocellular carcinoma. However, tumour recurrence rates are as high as 20%, and once the recurrence is established the therapeutic options are scarce and with little impact on prognosis. Strategies to minimize tumour recurrence and thus to improve outcome may be classified into 3 groups: (1) An adequate selection of candidates for liver transplantation by using the Milan criteria; (2) An optimized management within waiting list including prioritization of patients at high risk of tumour progression, and the implementation of bridging therapies, particularly when the expected length within the waiting list is longer than 6 mo; and (3) Tailored immunosuppression comprising reduced exposure to calcineurin inhibitors, particularly early after liver transplantation, and the addition of mammalian target of rapamycin inhibitors. In the present manuscript the available scientific evidence supporting these strategies is comprehensively reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more patients with hepatocellular carcinoma and with an improved long term outcome.
肝移植是唯一能够同时治疗肝细胞癌和潜在肝脏疾病的治疗选择。事实上，肝移植被认为是一部分肝硬化和肝细胞癌患者的标准治疗方法。然而，肿瘤复发率高达20%，一旦复发，治疗选择有限且对预后影响甚微。将肿瘤复发降至最低从而改善预后的策略可分为三类：（1）通过使用米兰标准对肝移植候选者进行充分筛选；（2）在等待名单内进行优化管理，包括对肿瘤进展高危患者进行优先排序，以及实施桥接治疗，特别是当预计在等待名单内的时间超过6个月时；（3）定制免疫抑制方案，包括减少钙调神经磷酸酶抑制剂的暴露，尤其是在肝移植术后早期，并添加雷帕霉素靶蛋白抑制剂。在本手稿中，全面回顾了支持这些策略的现有科学证据，并为新的研究方法提供了未来方向，这可能有助于实现最终目标：治愈更多肝细胞癌患者并改善长期预后。
