Ogawa Kohei, Takada Yasutsugu
Department of HBP and Breast Surgery, Ehime University, Ehime, Japan.
Transl Gastroenterol Hepatol. 2016 May 4;1:35. doi: 10.21037/tgh.2016.04.03. eCollection 2016.
With the scarcity of deceased donor liver grafts, living donor liver transplantation (LDLT) is gaining popularity as an alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, as the evidence of cases of LDLT accumulates, several authors have reported higher HCC recurrence rates after LDLT. The suggested reasons for the higher recurrence rates following LDLT are related to the small-for-size graft in LDLT, surgical procedures that are specific to LDLT, and the fast-track to LDLT. Fast-tracking to LDLT may not allow sufficient time for evaluation of the biological aggressiveness of tumors, which may result in high recurrence rates due to inclusion of patients with more inherently aggressive tumors. Actually, some studies that reported higher recurrence rates with LDLT included a larger number of cases of HCC with microvascular invasion or poorly differentiated HCC. In order to exclude biologically aggressive HCC preoperatively, selection criteria incorporating tumor markers, such as alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP), as well as morphological tumor number and size have been proposed. With more reliable selection criteria incorporating biological markers to eliminate biologically aggressive HCC, LDLT can be a viable treatment option for patients with HCC, providing similar recurrence rates as those achieved with DDLT.
随着尸体供肝的稀缺，活体供肝肝移植（LDLT）作为肝细胞癌（HCC）患者尸体供肝肝移植（DDLT）的替代方案正日益受到欢迎。然而，随着LDLT病例证据的积累，一些作者报告了LDLT后较高的HCC复发率。LDLT后复发率较高的推测原因与LDLT中体积过小的移植物、LDLT特有的手术操作以及LDLT的快速流程有关。LDLT的快速流程可能没有足够的时间来评估肿瘤的生物学侵袭性，这可能会由于纳入了具有更具侵袭性肿瘤的患者而导致高复发率。实际上，一些报告LDLT复发率较高的研究纳入了更多微血管侵犯或低分化HCC的病例。为了术前排除生物学侵袭性HCC，已经提出了结合肿瘤标志物（如甲胎蛋白（AFP）和去γ-羧基凝血酶原（DCP））以及肿瘤形态数量和大小的选择标准。有了更可靠的结合生物学标志物以消除生物学侵袭性HCC的选择标准，LDLT可以成为HCC患者可行的治疗选择，提供与DDLT相似的复发率。
