活体供肝肝移植可为肝癌患者提供更高的生存率，优于尸体供肝。
Live donor liver transplantation for patients with hepatocellular carcinoma offers increased survival vs. deceased donation.
机构信息
Multi-Organ Transplant Unit, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Canada; Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Canada.
Multi-Organ Transplant Unit, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Canada; Department of Medicine, University Health Network, University of Toronto, Canada.
出版信息
J Hepatol. 2019 Apr;70(4):666-673. doi: 10.1016/j.jhep.2018.12.029. Epub 2019 Jan 8.
BACKGROUND & AIMS: There are conflicting reports on the outcomes after live donor liver transplantation in patients with hepatocellular carcinoma (HCC). We aimed to compare the survival of patients with HCC, with a potential live donor (pLDLT) at listing vs. no potential donor (pDDLT), on an intention-to-treat basis.
METHODS
All patients with HCC listed for liver transplantation between 2000-2015 were included. The pLDLT group was comprised of recipients with a potential live donor identified at listing. Patients without a live donor were included in the pDDLT group. Survival was assessed by the Kaplan-Meier method. Multivariable Cox regression was applied to identify potential predictors of mortality.
RESULTS
A total of 219 patients were included in the pLDLT group and 632 patients in the pDDLT group. In the pLDLT group, 57 patients (26%) were beyond the UCSF criteria whereas 119 patients (19%) in the pDDLT group were beyond (p = 0.02). Time on the waiting list was shorter for the pLDLT than the pDDLT group (4.8 [2.9-8.5] months vs. 6.2 [3.0-12.0] months, respectively, p = 0.02). The dropout rate was 32/219 (14.6%) in the pLDLT and 174/632 (27.5%) in the pDDLT group, p <0.001. The 1-, 3- and 5-year intention-to-treat survival rates were 86%, 72% and 68% in the pLDLT vs. 82%, 63% and 57% in the pDDLT group, p = 0.02. Having a potential live donor was a protective factor for death (hazard ratio [HR] 0.67; 95% CI 0.53-0.86). Waiting times of 9-12 months (HR 1.53; 95% CI 1.02-2.31) and ≥12 months (HR 1.69; 95% CI 1.23-2.32) were predictors of death.
CONCLUSION
Having a potential live donor at listing was associated with a significant decrease in the risk of death in patients with HCC in this intention-to-treat analysis. This benefit is related to a lower dropout rate and a shorter waiting period.
LAY SUMMARY
Liver transplantation (LT) offers the best chance of survival for patients with hepatocellular carcinoma and can be performed using grafts from deceased donors or live donors. In this work, we aimed to assess the differences in survival after live donor LT when compared to deceased donor LT. We studied 219 patients listed for live donor LT and 632 patients listed for deceased donor LT. Patients who had a potential live donor at the time of listing had a higher survival rate. Therefore, being listed for a live donor LT was a protective factor against death.
背景与目的
在肝癌（HCC）患者中，活体供肝肝移植后的结局存在相互矛盾的报告。我们旨在根据意向治疗原则，比较 HCC 患者中潜在活体供体（pLDLT）与无潜在供体（pDDLT）患者的生存情况。
方法
纳入 2000-2015 年期间接受肝移植的所有 HCC 患者。pLDLT 组由在入组时确定的潜在活体供者的受者组成。没有活体供体的患者被纳入 pDDLT 组。采用 Kaplan-Meier 法评估生存情况。采用多变量 Cox 回归分析识别死亡的潜在预测因素。
结果
共纳入 219 例 pLDLT 组患者和 632 例 pDDLT 组患者。在 pLDLT 组中，57 例（26%）超出了 UCSF 标准，而 pDDLT 组中 119 例（19%）超出（p=0.02）。pLDLT 组的等待时间短于 pDDLT 组（分别为 4.8[2.9-8.5]个月和 6.2[3.0-12.0]个月，p=0.02）。pLDLT 组的失访率为 32/219（14.6%），pDDLT 组为 174/632（27.5%），p<0.001。pLDLT 组的 1 年、3 年和 5 年意向治疗生存率分别为 86%、72%和 68%，pDDLT 组分别为 82%、63%和 57%，p=0.02。有潜在活体供体是死亡的保护因素（风险比[HR]0.67；95%CI 0.53-0.86）。9-12 个月（HR 1.53；95%CI 1.02-2.31）和≥12 个月（HR 1.69；95%CI 1.23-2.32）的等待时间是死亡的预测因素。
结论
在本意向治疗分析中，在 HCC 患者中，在入组时具有潜在活体供体与死亡风险显著降低相关。这种获益与较低的失访率和较短的等待时间有关。
平铺直叙
肝移植（LT）为肝癌患者提供了最佳的生存机会，并且可以使用来自已故供体或活体供体的移植物进行。在这项工作中，我们旨在评估与已故供体 LT 相比，活体供体 LT 后的生存差异。我们研究了 219 名接受活体供体 LT 入组的患者和 632 名接受已故供体 LT 入组的患者。在入组时具有潜在活体供体的患者具有更高的生存率。因此，接受活体供体 LT 是死亡的保护因素。
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