Division of Transplantation, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States, Organ Transplant Center, Memorial Şişli Hospital, İstanbul, Turkey.
Division of Transplantation, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States, Department of Surgery, Şişli Etfal Training and Research Hospital, İstanbul, Turkey.
Turk J Med Sci. 2021 Oct 21;51(5):2383-2395. doi: 10.3906/sag-2101-51.
BACKGROUND/AIM: With the increased experience in living donor liver transplantation (LDLT), it has been adopted for the treatment of hepatocellular carcinoma (HCC), with emerging discussions of criteria beyond tumor size and number. In contrast to deceased donor liver transplantation (DDLT), recipient selection for LDLT is not limited by organ allocation systems. We discuss herein the assessment, criteria, and experience with liver transplantation (LT) in HCC cases at a high-volume LDLT center.
Between August 2006 and December 2017, 191 adult LT HCC recipients with at least one-year follow-up were retrospectively analyzed.
In 191 patients, one-, three- and five-year survival rates were 87.2%, 81.6%, and 76.2%, respectively, including early postoperative mortality. In 174 patients with long-term follow-up, one-, three- and five-year disease-free survival rates were 91.6%, 87.7%, and 84.4%, respectively. When multivariate analysis was utilized, tumor differentiation was the only factor which statistically affected survival (p = 0.025).
LDLT allows us to push the limits forward and the question “Are the criteria always right?” is always on the table. We can conclude that, with the advantage of LDLT, every HCC patient deserves a case-by-case basis discussion for LT under scientific literature support. In borderline cases, tumor biopsy might help determine the decision for LT.
背景/目的：随着活体肝移植（LDLT）经验的增加，它已被用于治疗肝细胞癌（HCC），并且对于超出肿瘤大小和数量的标准也有了新的讨论。与尸体供肝移植（DDLT）不同，LDLT 的受者选择不受器官分配系统的限制。我们在此讨论了在高容量 LDLT 中心对 HCC 病例进行 LT 的评估、标准和经验。
在 2006 年 8 月至 2017 年 12 月期间，对 191 例至少随访 1 年的成人 LT HCC 受者进行了回顾性分析。
在 191 例患者中，包括术后早期死亡在内，1 年、3 年和 5 年的生存率分别为 87.2%、81.6%和 76.2%。在 174 例长期随访的患者中，1 年、3 年和 5 年无病生存率分别为 91.6%、87.7%和 84.4%。当进行多因素分析时，肿瘤分化是唯一对生存有统计学影响的因素（p=0.025）。
LDLT 使我们能够向前推进极限，并且“标准是否总是正确的？”的问题始终存在。我们可以得出结论，LDLT 的优势在于，每个 HCC 患者都应该在科学文献支持的基础上进行逐个病例的讨论，以确定是否适合进行 LT。在边界病例中，肿瘤活检可能有助于确定 LT 的决策。
