Division of GastroenterologyDepartment of MedicineUniversity of CaliforniaSan Francisco, San FranciscoCaliforniaUSA.
Division of Transplant SurgeryDepartment of SurgeryUniversity of CaliforniaSan Francisco, San FranciscoCaliforniaUSA.
Liver Transpl. 2022 Jul;28(7):1144-1157. doi: 10.1002/lt.26439. Epub 2022 Apr 16.
Living donor liver transplantation (LDLT) is an attractive option to decrease waitlist dropout, particularly for patients with hepatocellular carcinoma (HCC) who face lengthening waiting times. Using the United Network for Organ Sharing (UNOS) national database, trends in LDLT utilization for patients with HCC were evaluated, and post-LT outcomes for LDLT versus deceased donor liver transplantation (DDLT) were compared. From 1998 to 2018, LT was performed in 20,161 patients with HCC including 726 (3.6%) who received LDLT. The highest LDLT utilization was prior to the 2002 HCC Model for End-Stage Liver Disease (MELD) exception policy (17.5%) and dropped thereafter (3.1%) with a slight increase following the 6-month wait policy in 2015 (3.8%). LDLT was more common in patients from long-wait UNOS regions with blood type O, in those with larger total tumor diameter (2.3 vs. 2.1 cm, p = 0.02), and higher alpha-fetoprotein at LT (11.5 vs. 9.0 ng/ml, p = 0.04). The 5-year post-LT survival (LDLT 77% vs. DDLT 75%), graft survival (72% vs. 72%), and HCC recurrence (11% vs. 13%) were similar between groups (all p > 0.20). In conclusion, LDLT utilization for HCC has remained low since 2002 with only a slight increase after the 6-month wait policy introduction in 2015. Given the excellent post-LT survival, LDLT appears to be an underutilized but valuable option for patients with HCC, especially those at high risk for waitlist dropout.
活体肝移植 (LDLT) 是减少候补名单退出率的一种有吸引力的选择，尤其是对于面临等待时间延长的肝细胞癌 (HCC) 患者。本研究使用美国器官共享网络 (UNOS) 国家数据库，评估了 HCC 患者接受 LDLT 的趋势，并比较了 LDLT 与尸体供肝移植 (DDLT) 的移植后结局。1998 年至 2018 年，共对 20161 例 HCC 患者进行了 LT，其中 726 例 (3.6%) 接受了 LDLT。LDLT 的最高使用率是在 2002 年 HCC 终末期肝病模型 (MELD) 例外政策之前 (17.5%)，此后下降 (3.1%)，2015 年 6 个月等待政策后略有增加 (3.8%)。在 UNOS 等待时间较长的地区、血型为 O 型、总肿瘤直径较大 (2.3 与 2.1 cm，p=0.02) 以及 LT 时甲胎蛋白水平较高 (11.5 与 9.0 ng/ml，p=0.04) 的患者中，LDLT 更为常见。两组患者的 5 年移植后生存率 (LDLT 为 77%，DDLT 为 75%)、移植物生存率 (72% vs. 72%) 和 HCC 复发率 (11% vs. 13%) 相似 (均 p>0.20)。总之，自 2002 年以来，LDLT 用于 HCC 的使用率一直较低，仅在 2015 年 6 个月等待政策推出后略有增加。鉴于 LDLT 后出色的生存率，LDLT 似乎是 HCC 患者的一种未充分利用但有价值的选择，尤其是那些候补名单退出风险较高的患者。
