Zhu Bo, Wang Jinju, Li Hui, Chen Xing, Zeng Yong
Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
HPB (Oxford). 2019 Feb;21(2):133-147. doi: 10.1016/j.hpb.2018.11.004. Epub 2018 Nov 30.
The outcomes of living donor liver transplantation (LDLT) versus deceased donor liver transplantation (DDLT) for HCC patients were not well defined and it was necessary to reassess.
A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Google Scholar and WanFang database for eligible studies. Perioperative and survival outcomes of HCC patients underwent LDLT were pooled and compared to those underwent DDLT.
Twenty-nine studies with 5376 HCC patients were included. For HCC patients underwent LDLT and DDLT, there were comparable rates of overall survival (OS) (1-year, RR = 1.04, 95%CI = 1.00-1.09, P = 0.03; 3-year, RR = 1.03, 95%CI = 0.96-1.11, P = 0.39; 5-year, RR = 1.04, 95%CI = 0.95-1.13, P = 0.43), disease free survival (DFS) (1-year, RR = 1.00, 95%CI = 0.95-1.05, P = 0.99; 3-year, RR = 1.00, 95%CI = 0.94-1.08, P = 0.89; 5-year, RR = 1.01, 95%CI = 0.93-1.09, P = 0.85), recurrence (1-year, RR = 1.41, 95%CI = 0.72-2.77, P = 0.32; 3-year, RR = 0.89, 95%CI = 0.57-1.39, P = 0.60; and 5-year, RR = 0.85, 95%CI = 0.56-1.31, P = 0.47), perioperative mortality within 3 months (RR = 0.89, 95%CI = 0.50-1.59, p = 0.70) and postoperative complication (RR = 0.99, 95%CI = 0.70-1.39, P = 0.94). LDLT was associated with better 5-year intention-to-treat patient survival (ITT-OS) than DDLT (RR = 1.11, 95% CI = 1.01-1.22, P = 0.04).
This meta-analysis suggested that LDLT was not inferior to DDLT in consideration of comparable perioperative and survival outcomes. However, in terms of 5-year ITT-OS, LDLT was a possibly better choice for HCC patients.
肝癌患者活体肝移植（LDLT）与尸体肝移植（DDLT）的疗效尚不明确，有必要重新评估。
在PubMed、Embase、Cochrane图书馆、谷歌学术和万方数据库中进行全面的文献检索，以查找符合条件的研究。汇总接受LDLT的肝癌患者的围手术期和生存结果，并与接受DDLT的患者进行比较。
纳入了29项研究，共5376例肝癌患者。接受LDLT和DDLT的肝癌患者的总生存率（OS）（1年，RR = 1.04，95%CI = 1.00 - 1.09，P = 0.03；3年，RR = 1.03，95%CI = 0.96 - 1.11，P = 0.39；5年，RR = 1.04，95%CI = 0.95 - 1.13，P = 0.43）、无病生存率（DFS）（1年，RR = 1.00，95%CI = 0.95 - 1.05，P = 0.99；3年，RR = 1.00，95%CI = 0.94 - 1.08，P = 0.89；5年，RR = 1.01，95%CI = 0.93 - 1.09，P = 0.85）、复发率（1年，RR = 1.41，95%CI = 0.72 - 2.77，P = 0.32；3年，RR = 0.89，95%CI = 0.57 - 1.39，P = 0.60；5年，RR = 0.85，95%CI = 0.56 - 1.31，P = 0.47）、3个月内围手术期死亡率（RR = 0.89，95%CI = 0.50 - 1.59，P = 0.70）和术后并发症（RR = 0.99，95%CI = 0.70 - 1.39，P = 0.94）相当。LDLT与比DDLT更好的5年意向性治疗患者生存率（ITT - OS）相关（RR = 1.11，95%CI = 1.01 - 1.22，P = 0.04）。
这项荟萃分析表明，考虑到围手术期和生存结果相当，LDLT并不劣于DDLT。然而，就5年ITT - OS而言，LDLT对肝癌患者可能是更好的选择。
