Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2020 Mar 23;35(11):e69. doi: 10.3346/jkms.2020.35.e69.
Hepatocellular carcinoma (HCC) recurrence and development of de novo malignancy (DNM) after liver transplantation (LT) are the major causes of late recipient death.
We analyzed the incidence of extrahepatic DNM following living donor LT according to the status of pretransplant hepatic malignancy. We selected 2,076 adult patients who underwent primary LDLT during 7 years from January 2010 to December 2016.
The pretransplant hepatic malignancy group (n = 1,012) showed 45 cases (4.4%) of the following extrahepatic DNMs: posttransplant lymphoproliferative disease (PTLD) in 10; lung cancer in 10; stomach cancer in 6; colorectal cancer in 5; urinary bladder cancer in 3; and other cancers in 11. The pretransplant no hepatic malignancy group (n = 1,064) showed 25 cases (2.3%) of the following extrahepatic DNMs: colorectal cancer in 3; stomach cancer in 3; leukemia in 3; lung cancer in 3; PTLD in 2; prostate cancer in 2; and other cancers in 9. Incidences of extrahepatic DNM in the pretransplant hepatic malignancy and no hepatic malignancy groups were as follows: 1.1% and 0.5% at 1 year, 3.2% and 2.0% at 3 years, 4.6% and 2.5% at 5 years, and 5.4% and 2.8% at 8 years, respectively ( = 0.006). Their overall patient survival rates were as follows: 97.3% and 97.2% at 1 year, 91.6% and 95.9% at 3 years, 89.8% and 95.4% at 5 years, and 89.2% and 95.4% at 8 years, respectively ( < 0.001). Pretransplant hepatic malignancy was the only significant risk factor for posttransplant extrahepatic DNM.
Our results suggest that patients who had pretransplant hepatic malignancy be followed up more strictly because they have a potential risk of primary hepatic malignancy recurrence as well as a higher risk of extrahepatic DNM than patients without pretransplant hepatic malignancy.
肝癌（HCC）复发和肝移植（LT）后新发恶性肿瘤（DNM）的发展是导致受者晚期死亡的主要原因。
我们根据移植前肝恶性肿瘤的状况，分析了活体供肝 LT 后肝外 DNM 的发生率。我们选择了 2010 年 1 月至 2016 年 12 月 7 年间接受原发性 LDLT 的 2076 例成年患者。
移植前肝恶性肿瘤组（n = 1012）有 45 例（4.4%）发生以下肝外 DNM：移植后淋巴组织增生性疾病（PTLD）10 例；肺癌 10 例；胃癌 6 例；结直肠癌 5 例；膀胱癌 3 例；其他癌症 11 例。移植前无肝恶性肿瘤组（n = 1064）有 25 例（2.3%）发生以下肝外 DNM：结直肠癌 3 例；胃癌 3 例；白血病 3 例；肺癌 3 例；PTLD 2 例；前列腺癌 2 例；其他癌症 9 例。移植前肝恶性肿瘤和无肝恶性肿瘤组的肝外 DNM 发生率分别为：1 年时为 1.1%和 0.5%，3 年时为 3.2%和 2.0%，5 年时为 4.6%和 2.5%，8 年时为 5.4%和 2.8%（= 0.006）。两组患者的总生存率分别为：1 年时为 97.3%和 97.2%，3 年时为 91.6%和 95.9%，5 年时为 89.8%和 95.4%，8 年时为 89.2%和 95.4%（<0.001）。移植前肝恶性肿瘤是移植后肝外 DNM 的唯一显著危险因素。
我们的研究结果表明，与无移植前肝恶性肿瘤的患者相比，有移植前肝恶性肿瘤的患者更有发生原发性肝恶性肿瘤复发和肝外 DNM 的潜在风险，应更严格地随访。
