Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India.
Department of Pathology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India.
Indian J Gastroenterol. 2021 Jun;40(3):295-302. doi: 10.1007/s12664-020-01138-4. Epub 2021 May 21.
Living donor liver transplant (LDLT) for hepatocellular carcinoma (HCC) has been controversial in terms of selection and outcome. We share our experience of LDLT for HCC in Indian patients.
Retrospective analysis of patients undergoing LDLT for HCC discovered either preoperatively or incidentally on explant pathology was done. Preoperative characteristics and explant histopathology findings were recorded. Overall, recurrence-free survival and factors predicting recurrence were analyzed.
Six hundred and eleven LDLT were performed between June 2011 and October 2019. HCC constituted 6.5% (n = 53) of transplant activity. Forty had preoperative diagnosis, while 13 were detected incidentally. The median model for end-stage liver disease (MELD) score was 18 for patients with HCC. Only in 10 patients (19%), HCC was the primary indication for liver transplant (LT), and the rest had undergone transplant for progressive decompensation. Thirty-two patients were within up-to-7, while 21 were outside up-to-7 criteria. Overall 5-year survival was 85.4% and recurrence-free survival was 83.3% after a median follow-up of 35 months (13-59). This was similar to LDLT for other indications (81.2% at 5 years). Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score was best able to predict recurrence (p = 0.03) with odds ratio of 6.8.
Patients with HCC in India present late for liver transplant. Most patients have some form of decompensation before they undergo LT. In selected patients, overall survival was comparable with other indications for LDLT with acceptable recurrence rates. RETREAT score was best to predict recurrence.
对于肝细胞癌（HCC），活体肝移植（LDLT）的选择和结果一直存在争议。我们分享了我们在印度患者中进行 LDLT 治疗 HCC 的经验。
对接受 LDLT 治疗 HCC 的患者进行回顾性分析，这些 HCC 患者是在术前或移植肝切除标本的病理检查中发现的。记录术前特征和移植肝组织病理学发现。总体上，分析了无复发生存率和预测复发的因素。
2011 年 6 月至 2019 年 10 月期间共进行了 611 例 LDLT。HCC 占移植活动的 6.5%（n=53）。40 例术前诊断为 HCC，13 例为意外发现。HCC 患者的终末期肝病模型（MELD）评分中位数为 18。只有 10 例（19%）患者的 HCC 是肝移植的主要适应证，其余患者因进行性肝功能失代偿而行移植。32 例患者符合 up-to-7 标准，21 例患者不符合 up-to-7 标准。中位随访 35 个月（13-59 个月）后，整体 5 年生存率为 85.4%，无复发生存率为 83.3%。这与其他适应证的 LDLT 相似（5 年生存率为 81.2%）。风险评估肿瘤复发后移植（RETREAT）评分最能预测复发（p=0.03），其优势比为 6.8。
印度的 HCC 患者就诊较晚。大多数患者在接受 LT 之前已经存在某种程度的肝功能失代偿。在选择的患者中，总体生存率与 LDLT 治疗其他适应证相当，复发率可接受。RETREAT 评分是预测复发的最佳方法。
