Department of Medicine I, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
Department of General and Abdominal Surgery, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
United European Gastroenterol J. 2019 Jul;7(6):838-849. doi: 10.1177/2050640619840221. Epub 2019 Mar 25.
The recurrence of hepatocellular carcinoma (HCC) is the strongest survival-limiting factor after liver transplantation (LT) in patients with HCC. In the face of donor organ shortage, it is necessary to identify factors associated with HCC recurrence in order to maximize the utility of the available grafts.
To study the phenomenon of HCC recurrence after LT at a European transplantation centre over the past 20 years.
Data from 304 HCC patients who underwent LT were prospectively recorded. Clinical and pathological factors were assessed for their association with recurrence.
Fifty-one patients (16.8%) had HCC recurrence after LT. Patients exceeding the Milan criteria developed HCC recurrence more frequently. The time point of recurrence did not affect survival after recurrence. Furthermore, there was no difference in survival between patients with intra- and extrahepatic recurrence. However, patients with recurrence due to needle tract seeding had a significantly better outcome than patients with other sites of recurrence.
Our data support a restrictive use of patient selection criteria to help identify patients who have an increased risk of HCC recurrence after LT, and highlight the need to improve patient selection before LT in order to minimize the rate of HCC recurrence.
肝癌（HCC）在 HCC 患者接受肝移植（LT）后复发是生存的最强限制因素。面对供体器官短缺，有必要确定与 HCC 复发相关的因素，以最大限度地利用可用的移植物。
研究过去 20 年来欧洲移植中心 LT 后 HCC 复发的现象。
前瞻性记录了 304 例 HCC 患者接受 LT 的数据。评估了临床和病理因素与复发的关系。
51 例（16.8%）患者在 LT 后发生 HCC 复发。超过米兰标准的患者 HCC 复发更为频繁。复发的时间点并不影响复发后的生存。此外，肝内和肝外复发的患者之间的生存率没有差异。然而，由于针道种植引起复发的患者的生存结果明显好于其他部位复发的患者。
我们的数据支持对患者选择标准进行限制使用，以帮助确定 LT 后 HCC 复发风险增加的患者，并强调需要在 LT 前改进患者选择，以最大限度地降低 HCC 复发率。
