Pinheiro Rafael S, Waisberg Daniel R, Nacif Lucas S, Rocha-Santos Vinicius, Arantes Rubens M, Ducatti Liliana, Martino Rodrigo B, Lai Quirino, Andraus Wellington, D'Albuquerque Luiz A C
Digestive Organs Transplant Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Transplant Unit, Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
Transl Gastroenterol Hepatol. 2017 Aug 29;2:68. doi: 10.21037/tgh.2017.08.02. eCollection 2017.
Hepatocellular carcinoma (HCC) is the fifth most prevalent cancer and it is linked with chronic liver disease. Liver transplantation (LT) is the best curative treatment modality, since it can cure simultaneously the underlying liver disease and HCC. Milan criteria (MC) are the benchmark for selecting patients with HCC for LT, achieving up to 91% 1-year survival post transplantation. However, when considering intention-to-treat (ITT) rates are substantially lower, mainly due dropout. Additionally, Milan criteria (MC) are too restrictive and more inclusive criteria have been reported with good outcomes. Mainly, in Eastern countries, deceased donors are scarce, therefore Asian centers have developed living-donor liver transplantation (LDLT) to a state-of-art status. There are many eastern centers reporting huge numbers of LDLT with outstanding results. Regarding HCC patients, they have reported many criteria including more advanced tumors achieving reasonable outcomes. Western countries have well-established deceased-donor liver transplantation (DDLT) programs. However, organ shortage and restrictive criteria for listing patients with HCC endorses LDLT as a good option to offer curative treatment to more HCC patients. However, there are some controversial reports claiming higher rates of HCC recurrence after LDLT than DDLT. An extensive review included 30 studies with cohorts of HCC patients who underwent LDLT in both East and West countries. We reported also the results of our Institution, in Brazil, where it was performed the first LDLT. This review also addresses the eligibility criteria for transplanting patients with HCC developed in Western and Eastern countries.
肝细胞癌（HCC）是第五大常见癌症，与慢性肝病相关。肝移植（LT）是最佳的治愈性治疗方式，因为它能同时治愈潜在的肝病和HCC。米兰标准（MC）是选择HCC患者进行肝移植的基准，移植后1年生存率可达91%。然而，考虑意向性治疗（ITT）率时则要低得多，主要是由于失访。此外，米兰标准（MC）过于严格，已有报道称采用更具包容性的标准能取得良好疗效。主要在东方国家，脑死亡供体稀缺，因此亚洲中心已将活体肝移植（LDLT）发展到了先进水平。有许多东方中心报告了大量活体肝移植案例，结果出色。对于HCC患者，他们报告了许多标准，包括对更晚期肿瘤采用这些标准也能取得合理疗效。西方国家有成熟的脑死亡供体肝移植（DDLT）项目。然而，器官短缺以及HCC患者入列标准的限制使得活体肝移植成为为更多HCC患者提供治愈性治疗的一个不错选择。然而，有一些有争议的报告称，活体肝移植后HCC复发率高于脑死亡供体肝移植。一项广泛的综述纳入了30项研究，这些研究的队列是东西方国家接受活体肝移植的HCC患者。我们还报告了我们在巴西的机构的结果，巴西进行了首例活体肝移植。本综述还讨论了东西方国家制定的HCC患者移植资格标准。
