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肝细胞癌肝移植的结局:来自越南一个中心的经验。

Outcomes of liver transplantation for hepatocellular carcinoma: Experiences from a Vietnamese center.

作者信息

Ninh Khai Viet, Do Dang Hai, Nguyen Trung Duc, Tran Phuong Ha, Hoang Tuan, Le Dung Thanh, Nguyen Nghia Quang

机构信息

Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam.

Department of General Surgery, Hanoi Medical University, Hanoi, Vietnam.

出版信息

Ann Hepatobiliary Pancreat Surg. 2024 Feb 29;28(1):34-41. doi: 10.14701/ahbps.23-072. Epub 2024 Jan 9.

Abstract

BACKGROUNDS/AIMS: Liver transplantation (LT) provides a favorable outcome for patients with hepatocellular carcinoma (HCC) and was launched in Vietnam in 2004. In this study, we evaluated the short-term and long-term outcomes of LT and its risk factors.

METHODS

This retrospective study analyzed HCC patients who underwent LT at Viet Duc University hospital, Vietnam, from 01/2012-03/2022. The following data were gathered: demographics, virus infection, tumor characteristics, alpha-fetoprotein (AFP) level, Child-Pugh and MELD scores, selection criteria, type of LT, complications, 30-day mortality, and disease-free and overall survival (DFS and OS).

RESULTS

Fifty four patients were included, the mean age was 55.39 ± 8.46 years. Nearly 90% had hepatitis B virus-related HCC. The median (interquartile range) AFP level was 16.2 (88.7) ng/mL. The average MELD score was 10.57 ± 5.95; the rate of Child-Pugh A and B were 70.4% and 18.5%, respectively. Nearly 40% of the patients were within Milan criteria, brain-dead donor was 83.3%. Hepatic and portal vein thrombosis occurred in 0% and 1.9%, respectively; hepatic artery thrombosis 1.9%, biliary leakage 5.6%, and postoperative hemorrhage 3.7%. Ninety-day mortality was 5.6%. Five-year DFS and OS were 79.3% and 81.4%, respectively. MELD score and Child-Pugh score were predictive factors for DFS and OS ( < 0.05). In multivariate analysis, Child-Pugh score was the only significant factor ( < 0.05).

CONCLUSIONS

In Vietnam, LT is an effective therapy for HCC with an acceptable complication rate, mortality rate, and good survival outcomes, and should be further encouraged.

摘要

背景/目的:肝移植(LT)为肝细胞癌(HCC)患者带来了良好的治疗效果,并于2004年在越南开展。在本研究中,我们评估了肝移植的短期和长期疗效及其危险因素。

方法

这项回顾性研究分析了2012年1月至2022年3月在越南越德大学医院接受肝移植的肝癌患者。收集了以下数据:人口统计学资料、病毒感染情况、肿瘤特征、甲胎蛋白(AFP)水平、Child-Pugh和MELD评分、选择标准、肝移植类型、并发症、30天死亡率以及无病生存期和总生存期(DFS和OS)。

结果

共纳入54例患者,平均年龄为55.39±8.46岁。近90%的患者患有乙型肝炎病毒相关的肝癌。AFP水平的中位数(四分位间距)为16.2(88.7)ng/mL。平均MELD评分为10.57±5.95;Child-Pugh A级和B级的比例分别为70.4%和18.5%。近40%的患者符合米兰标准,脑死亡供体为83.3%。肝静脉和门静脉血栓形成的发生率分别为0%和1.9%;肝动脉血栓形成1.9%,胆漏5.6%,术后出血3.7%。90天死亡率为5.6%。五年DFS和OS分别为79.3%和81.4%。MELD评分和Child-Pugh评分是DFS和OS的预测因素(<0.05)。在多变量分析中,Child-Pugh评分是唯一的显著因素(<0.05)。

结论

在越南,肝移植是治疗肝癌的有效方法,并发症发生率、死亡率可接受,生存结果良好,应进一步推广。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ee3/10896682/14ad728b6502/ahbps-28-1-34-f1.jpg

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