Sugawara Yasuhiko, Inomata Yukihiro
Department of Transplantation/Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan.
Hepatobiliary Surg Nutr. 2016 Oct;5(5):429-432. doi: 10.21037/hbsn.2016.09.01.
Liver transplantation is the optimal radical therapy for patients with cirrhosis and hepatocellular carcinoma (HCC). The Milan criteria are widely applied for deceased donor liver transplantation (DDLT) in the western countries. Living donor liver transplantation (LDLT), however, prevails in Asian countries due to the extreme shortage of deceased donor organs. In contrast to DDLT, the feasibility of LDLT is not restricted by the national allocation system, and therefore the indications for LDLT in patients with HCC depend on institutional policies that consider both the operative risk to the donor and the survival benefit for the recipient. The results of a nationwide survey as well as the experiences of individual centers demonstrate similar outcomes for patients whose tumors fall within the Milan criteria and those whose tumors extend beyond the Milan criteria.
肝移植是肝硬化和肝细胞癌（HCC）患者的最佳根治性治疗方法。米兰标准在西方国家广泛应用于尸体供肝肝移植（DDLT）。然而，由于尸体供肝极度短缺，活体供肝肝移植（LDLT）在亚洲国家更为普遍。与DDLT不同，LDLT的可行性不受国家分配系统的限制，因此，HCC患者LDLT的适应证取决于机构政策，该政策既要考虑供体的手术风险，也要考虑受体的生存获益。一项全国性调查的结果以及各个中心的经验表明，肿瘤符合米兰标准的患者与肿瘤超出米兰标准的患者预后相似。
