Division of Abdominal Transplant, Department of General Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Division of Abdominal Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Ann Surg Oncol. 2023 May;30(5):2769-2777. doi: 10.1245/s10434-023-13147-6. Epub 2023 Jan 31.
Current success in transplant oncology for select liver tumors, such as hepatocellular carcinoma, has ignited international interest in liver transplantation (LT) as a therapeutic option for nonresectable colorectal liver metastases (CRLM). In the United States, the CRLM LT experience is limited to reports from a handful of centers. This study was designed to summarize donor, recipient, and transplant center characteristics and posttransplant outcomes for the indication of CRLM.
Adult, primary LT patients listed between December 2017 and March 2022 were identified by using United Network Organ Sharing database. LT for CRLM was identified from variables: "DIAG_OSTXT"; "DGN_OSTXT_TCR"; "DGN2_OSTXT_TCR"; and "MALIG_TY_OSTXT."
During this study period, 64 patients were listed, and 46 received LT for CRLM in 15 centers. Of 46 patients who underwent LT for CRLM, 26 patients (56.5%) received LTs using living donor LT (LDLT), and 20 patients received LT using deceased donor (DDLT) (43.5%). The median laboratory MELD-Na score at the time of listing was statistically similar between the LDLT and DDLT groups (8 vs. 9, P = 0.14). This persisted at the time of LT (8 vs. 12, P = 0.06). The 1-, 2-, and 3-year, disease-free, survival rates were 75.1, 53.7, and 53.7%. Overall survival rates were 89.0, 60.4, and 60.4%, respectively.
This first comprehensive U.S. analysis of LT for CRLM suggests a burgeoning interest in high-volume U.S. transplant centers. Strategies to optimize patient selection are limited by the scarce oncologic history provided in UNOS data, warranting a separate registry to study LT in CRLM.
目前，在选择肝脏肿瘤（如肝细胞癌）的移植肿瘤学方面取得的成功，激发了国际上对肝移植（LT）作为不可切除结直肠癌肝转移（CRLM）治疗选择的兴趣。在美国，CRLM LT 的经验仅限于少数中心的报告。本研究旨在总结 CRLM 适应证的供体、受体和移植中心特征和移植后结果。
通过使用美国器官共享网络数据库，确定了 2017 年 12 月至 2022 年 3 月期间列出的成人原发性 LT 患者。通过以下变量识别 LT 用于 CRLM：“DIAG_OSTXT”；“DGN_OSTXT_TCR”；“DGN2_OSTXT_TCR”；和“MALIG_TY_OSTXT”。
在本研究期间，共列出了 64 例患者，其中 46 例在 15 个中心接受 LT 治疗 CRLM。在接受 LT 治疗 CRLM 的 46 例患者中，26 例（56.5%）接受了活体供体 LT（LDLT），20 例接受了尸体供体 LT（DDLT）（43.5%）。在 LDLT 和 DDLT 组之间，在列时的中位实验室 MELD-Na 评分在统计学上无显著差异（8 与 9，P=0.14）。这一结果在 LT 时仍然存在（8 与 12，P=0.06）。1、2 和 3 年无病生存率分别为 75.1%、53.7%和 53.7%。总生存率分别为 89.0%、60.4%和 60.4%。
这是美国首次对 CRLM 进行的 LT 全面分析，表明美国大型移植中心对此兴趣日益浓厚。由于 UNOS 数据中提供的肿瘤学病史很少，因此优化患者选择的策略受到限制，需要单独的登记处来研究 CRLM 中的 LT。
