Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique [IREC], Université catholique de Louvain [UCL], Brussels, Belgium.
Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique [IREC], Université catholique de Louvain [UCL], Brussels, Belgium; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Hepatobiliary Pancreat Dis Int. 2019 Oct;18(5):412-422. doi: 10.1016/j.hbpd.2019.08.005. Epub 2019 Aug 25.
During the last decades, deceased-donor liver transplantation (DDLT) has gained a place in the therapeutic algorithm of well-selected patients harbouring non-resectable secondary liver tumors. Living-donor LT (LDLT) might represent a valuable means to further expand this indication for LT.
Between 1985 and 2016, twenty-two adults were transplanted because of neuroendocrine (n = 18, 82%) and colorectal metastases (n = 4, 18%); 50% received DDLT and 50% LDLT. In LDLT, 4 (36%) right and 7 (64%) left grafts were used; the median graft-to-recipient-weight ratios (GRWR) were 1.03% (IQR 0.86%-1.30%) and 0.59% (IQR 0.51%-0.91%), respectively. Median post-LT follow-up was 64 months (IQR 17-107) in the DDLT group and 40 months (IQR 35-116) in the LDLT group. DDLT and LDLT recipients were compared in terms of overall survival, graft survival, postoperative complications and recurrence.
The 1- and 5-year actuarial patient survivals were 82% and 55% after DDLT, 100% and 100% after LDLT, respectively (P < 0.01). One- and 5-year actuarial graft survivals were 73% and 36% after DDLT, 91% and 91% after LDLT (P < 0.01). The outcomes of right or left LDLT were comparable. Donor hepatectomy proved safe, and one donor experienced a Clavien IIIb complication. Bilirubin peak was significantly lower after left hepatectomy compared with that after right hepatectomy [1.3 (IQR 1.2-2.2) vs. 3.3 (IQR 2.3-5.2) mg/dL; P = 0.02].
The more recent LDLT series compared favorably to our DDLT series in the treatment of secondary liver malignancies. The absence of portal hypertension and the use of smaller left grafts make recipient and donor surgeries safe. The safety of the procedures and lack of interference with the scarce allograft pool are expected to lead to a more frequent use of LDLT in the field of transplant oncology.
在过去的几十年中，对于患有不可切除的继发性肝肿瘤的精选患者，已故供体肝移植（DDLT）已在治疗方案中占据一席之地。活体供体肝移植（LDLT）可能是进一步扩大 LT 适应证的一种有价值的手段。
1985 年至 2016 年，22 例成人因神经内分泌（n=18，82%）和结直肠转移（n=4，18%）接受移植；50%接受 DDLT，50%接受 LDLT。在 LDLT 中，4 例（36%）使用右半肝，7 例（64%）使用左半肝；中位移植物与受体体重比（GRWR）分别为 1.03%（IQR 0.86%-1.30%）和 0.59%（IQR 0.51%-0.91%）。DDLT 组和 LDLT 组的中位 LT 后随访时间分别为 64 个月（IQR 17-107）和 40 个月（IQR 35-116）。在总体生存率、移植物生存率、术后并发症和复发方面，比较了 DDLT 和 LDLT 受者。
DDLT 组 1 年和 5 年的患者存活率分别为 82%和 55%，LDLT 组分别为 100%和 100%（P<0.01）。DDLT 组 1 年和 5 年的移植物存活率分别为 73%和 36%，LDLT 组分别为 91%和 91%（P<0.01）。右或左 LDLT 的结果相当。供肝切除术是安全的，1 例供者发生 Clavien IIIb 级并发症。与右半肝切除术相比，左半肝切除术的胆红素峰值明显较低[1.3（IQR 1.2-2.2）比 3.3（IQR 2.3-5.2）mg/dL；P=0.02]。
与我们的 DDLT 系列相比，最近的 LDLT 系列在治疗继发性肝恶性肿瘤方面表现更好。没有门静脉高压和使用较小的左半肝移植物使受体和供体手术更加安全。该手术的安全性以及不会干扰稀缺的同种异体供体库，预计将导致 LDLT 在移植肿瘤学领域的更频繁使用。
