亲体肝移植与尸体肝移植治疗米兰标准内或标准外肝癌：长期疗效相当。
Living Donor Liver Transplantation Versus Deceased Donor Liver Transplantation for Hepatocellular Carcinoma Within or Beyond the Milan Criteria: Comparable Long-Term Outcomes.
机构信息
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
Transplant Proc. 2021 Jan-Feb;53(1):92-97. doi: 10.1016/j.transproceed.2020.10.012. Epub 2020 Dec 5.
BACKGROUND
The long-term outcomes after living donor liver transplantation (LDLT) vs deceased donor liver transplantation (DDLT) for hepatocellular carcinoma (HCC) remain controversial. We compared the long-term outcomes between LDLT and DDLT in patients with HCCs within or beyond the Milan criteria.
METHODS
This retrospective study included 896 patients who underwent liver transplantation (829 LDLTs and 67 DDLTs) for HCC from June 2005 to May 2015. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method with log-rank test.
RESULTS
RFS at 1, 3, 5, and 10 years after LDLT was 89.6%, 84.6%, 82.4%, and 79.6%, respectively, and, after DDLT, was 92.4%, 86.2%, 82.4%, and 82.4%, respectively, and OS at 1, 3, 5, and 10 years after LDLT was 96.1%, 88.1%, 85.6%, and 82.7%, respectively, and, after DDLT, was 97.0%, 83.6%, 82.1%, and 77.3%, respectively, with no significant differences in RFS (P = .838) or OS (P = .293) between groups. No statistically significant differences after LDLT or DDLT were identified in RFS (89.8% vs 98.1%, respectively, at 5 years; P = .053) or OS (90.4% vs 90.6% , respectively, at 5 years; P = .583) for HCCs meeting the Milan criteria as well as for those beyond the Milan criteria (RFS, 37.8% vs 28.6%, respectively, at 5 years; P = .560 and OS, 57.3% vs 50.0%, respectively, at 5 years; P = .743).
CONCLUSIONS
Patients who underwent LDLT for HCCs showed comparable long-term outcomes to patients who underwent DDLT. Patients with HCCs within the Milan criteria demonstrated acceptable long-term outcomes after both LDLT and DDLT.
背景
活体肝移植（LDLT）与死后肝移植（DDLT）治疗肝细胞癌（HCC）的长期结果仍存在争议。我们比较了米兰标准内和标准外 HCC 患者在 LDLT 和 DDLT 中的长期结果。
方法
本回顾性研究纳入了 2005 年 6 月至 2015 年 5 月期间接受肝移植（829 例 LDLT 和 67 例 DDLT）治疗 HCC 的 896 例患者。使用 Kaplan-Meier 方法和对数秩检验估计无复发生存率（RFS）和总体生存率（OS）。
结果
LDLT 后 1、3、5 和 10 年的 RFS 分别为 89.6%、84.6%、82.4%和 79.6%，而 DDLT 后分别为 92.4%、86.2%、82.4%和 82.4%，LDLT 后 1、3、5 和 10 年的 OS 分别为 96.1%、88.1%、85.6%和 82.7%，而 DDLT 后分别为 97.0%、83.6%、82.1%和 77.3%，两组间 RFS（P=0.838）或 OS（P=0.293）无显著差异。符合米兰标准的 HCC 患者以及超出米兰标准的 HCC 患者，在 LDLT 或 DDLT 后，RFS（分别为 5 年时 89.8%对 98.1%；P=0.053）或 OS（分别为 90.4%对 90.6%；P=0.583）无显著差异。符合米兰标准的 HCC 患者 RFS（分别为 5 年时 37.8%对 28.6%；P=0.560）和 OS（分别为 5 年时 57.3%对 50.0%；P=0.743），超出米兰标准的 HCC 患者 RFS（分别为 5 年时 31.2%对 25.3%；P=0.460）和 OS（分别为 5 年时 54.4%对 48.2%；P=0.660）无显著差异。
结论
接受 LDLT 治疗 HCC 的患者与接受 DDLT 治疗的患者具有可比的长期结果。符合米兰标准的 HCC 患者在 LDLT 和 DDLT 后均获得可接受的长期结果。
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