现行的分配政策有利于等待肝移植的肝细胞癌患者。

Current allocation policy is favorable for patients with hepatocellular carcinoma waiting for liver transplantation.

机构信息

Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain.

出版信息

Dig Liver Dis. 2018 Dec;50(12):1345-1350. doi: 10.1016/j.dld.2018.04.024. Epub 2018 May 3.

DOI:10.1016/j.dld.2018.04.024

PMID:29807872

Abstract

BACKGROUND

Patients with hepatocellular carcinoma (HCC) are a growing population of the transplantation waiting list (WL) for orthotopic liver transplantation (OLT). There is no consensus to prioritize these patients while on the WL.

AIMS

To assess whether patients with HCC were more prioritized than non-HCC patients based on their WL survival as primary outcome.

METHODS

Restrospective cohort study including patients listed for elective OLT from January 2013 to January 2016.

RESULTS

165 patients with cirrhosis were listed for OLT: 64 in the HCC group (38.78%) and 101 in the non-HCC group (61.22%). Outcomes (HCC vs. non-HCC) were: OLT in 75.51% vs. 64.37%; death or dropout due to worsening in 20.41% vs. 27.59%, and delisting because of improvement in 4.08% vs. 8.05%. HCC patients had a significantly higher WL survival rate (HR = 0.45; 95% CI: 0.21-0.96); lower MELD score at transplantation (21 [20-24] vs. 24 [20-30]; p = 0.021); higher delta-MELD - the difference between MELD at transplantation and MELD at listing time - (3 [2-6] vs. 0 [0-5]; p = 0.024) and longer waiting time until OLT (143 [70-233] vs. 67 [21-164] days; p = 0.008).

CONCLUSION

Despite having to wait longer, patients with HCC showed higher WL survival than non-HCC patients.

摘要

背景

肝细胞癌（HCC）患者是接受原位肝移植（OLT）的移植候补名单（WL）上不断增加的人群。目前，对于 WL 上的 HCC 患者是否应该优先考虑，尚无共识。

目的

以 WL 生存为主要结局，评估 HCC 患者是否比非 HCC 患者更优先。

方法

回顾性队列研究，纳入 2013 年 1 月至 2016 年 1 月接受择期 OLT 的患者。

结果

165 例肝硬化患者被列入 OLT 候补名单：HCC 组 64 例（38.78%），非 HCC 组 101 例（61.22%）。结果（HCC 与非 HCC）为：OLT 分别为 75.51%和 64.37%；因病情恶化导致死亡或退出分别为 20.41%和 27.59%，因改善而被取消资格分别为 4.08%和 8.05%。HCC 患者的 WL 生存率显著较高（HR=0.45；95%CI：0.21-0.96）；移植时 MELD 评分较低（21 [20-24] vs. 24 [20-30]；p=0.021）；delta-MELD（移植时的 MELD 与列入候补名单时的 MELD 之差）较高（3 [2-6] vs. 0 [0-5]；p=0.024），等待 OLT 的时间较长（143 [70-233] vs. 67 [21-164]天；p=0.008）。