Guo Yuxin, Tan Ek-Khoon, Krishnamoorthy Thinesh-Lee, Tan Chee-Kiat, Tan Ban-Hock, Tan Thuan-Tong, Lee Ser-Yee, Chan Chung-Yip, Cheow Peng-Chung, Chung Alexander Y F, Jeyaraj Prema Raj, Goh Brian K P
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Ann Hepatobiliary Pancreat Surg. 2019 Feb;23(1):1-7. doi: 10.14701/ahbps.2019.23.1.1. Epub 2019 Feb 28.
BACKGROUNDS/AIMS: Salvage liver transplantation (SLT) is a therapeutic strategy for recurrent hepatocellular carcinoma (HCC). However, it remains controversial with compromised survival outcomes and increased perioperative morbidity compared to primary liver transplant (PLT). In the present work, we describe our institution's experience on SLT by comparing outcomes of SLT to PLT for HCCs.
Retrospective analysis was conducted for 49 transplant patients from 2006-2017. A comparative analysis was carried out between 14 SLT patients and 35 PLT patients.
SLT patients demonstrated significantly shorter time to recurrence than PLT patients (median=5.5 versus 23 months, <0.001) with a trend towards increased perioperative major morbidity (42.9% versus 37%, =0.711), inferior 5-year overall survival (61% versus 75%, =0.345) and inferior 5-year recurrence-free survival (57% versus 72%, =0.263). However, overall survival from the point of primary resection over a 10-year period showed no statistical difference between the 2 groups (SLT=60% versus PLT=61%, =0.685).
SLT is a viable treatment strategy for HCCs. However, it exhibited poorer short-term perioperative and oncologic outcomes than PLT. SLT requires better patient selection with liver donor grafts for optimization of resource allocation in this era of organ shortage. Considering the worldwide shortages in liver grafts, it is hypothesized that optimization of a salvage transplant strategy may improve resource allocation and reap optimal patient outcomes.
背景/目的：挽救性肝移植（SLT）是复发性肝细胞癌（HCC）的一种治疗策略。然而，与初次肝移植（PLT）相比，其生存结果受损且围手术期发病率增加，这一点仍存在争议。在本研究中，我们通过比较SLT与PLT治疗HCC的结果，描述了我们机构在SLT方面的经验。
对2006年至2017年的49例移植患者进行回顾性分析。对14例SLT患者和35例PLT患者进行了对比分析。
SLT患者的复发时间明显短于PLT患者（中位数分别为5.5个月和23个月，<0.001），围手术期主要发病率有增加趋势（42.9%对37%，=0.711），5年总生存率较低（61%对75%，=0.345），5年无复发生存率较低（57%对72%，=0.263）。然而，两组在10年期间从初次切除开始的总生存率无统计学差异（SLT为60%，PLT为61%，=0.685）。
SLT是HCC的一种可行治疗策略。然而，与PLT相比，它在围手术期短期和肿瘤学结果方面表现较差。在这个器官短缺的时代，SLT需要更好地选择患者和肝脏供体移植物，以优化资源分配。考虑到全球肝脏移植物短缺的情况，推测优化挽救性移植策略可能会改善资源分配并获得最佳患者结果。
