Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China.
Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China.
Clin Res Hepatol Gastroenterol. 2016 Jun;40(3):315-326. doi: 10.1016/j.clinre.2015.08.003. Epub 2015 Sep 14.
The different outcomes of deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) are currently being debated. We aimed to retrospectively compare the outcomes following LDLT and DDLT and to analyse the factors influencing this.
We compared the overall survival (OS) and disease-free survival (DFS) rates of HCC patients after LDLT (n=389) and DDLT (n=6471) from 81 centres over a 10-year period. OS and DFS rates were calculated with the Kaplan-Meier method. And univariate and multivariate Cox proportional hazards regressions were performed on the entire cohort to identify predictors.
Of 6860 patients, the 1-, 3-, and 5-year OS rates were 86.79%, 70.16%, and 66.31% after LDLT, respectively, and 74.2%, 54.21%, and 46.97% after DDLT, respectively (P<0.001). The 1-, 3-, and 5-year DFS rates were 78.46%, 63.68%, and 61.63% after LDLT, respectively, and 65.65%, 48.61%, and 41.87% after DDLT, respectively (P<0.001). The multivariate Cox regression model determined that the DFS and OS of HCC patients post-liver transplantation (LT) were strongly associated with tumour morphology and biology, but not graft type.
With regards to OS and DFS, there were no disadvantages to LDLT as compared with DDLT; tumour morphology and biology may affect the prognosis of LT.
目前，关于 deceased donor liver transplantation（DDLT）和 living donor liver transplantation（LDLT）治疗肝细胞癌（HCC）的不同结果仍存在争议。本研究旨在回顾性比较 LDLT 和 DDLT 后的结局，并分析影响这些结果的因素。
我们比较了 81 个中心的 389 例 LDLT 患者和 6471 例 DDLT 患者的总体生存率（OS）和无病生存率（DFS）。采用 Kaplan-Meier 法计算 OS 和 DFS 率。对整个队列进行单因素和多因素 Cox 比例风险回归分析，以确定预测因素。
在 6860 例患者中，LDLT 后 1、3、5 年的 OS 率分别为 86.79%、70.16%和 66.31%，DDLT 后分别为 74.2%、54.21%和 46.97%（P<0.001）。LDLT 后 1、3、5 年的 DFS 率分别为 78.46%、63.68%和 61.63%，DDLT 后分别为 65.65%、48.61%和 41.87%（P<0.001）。多因素 Cox 回归模型确定，肝移植（LT）后 HCC 患者的 DFS 和 OS 与肿瘤形态和生物学密切相关，但与移植物类型无关。
在 OS 和 DFS 方面，LDLT 与 DDLT 相比没有劣势；肿瘤形态和生物学可能影响 LT 的预后。
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