在心跳死亡后捐献与脑死亡后捐献的肝移植治疗肝细胞癌的结局比较：系统评价和荟萃分析。

Outcomes of liver transplantation for hepatocellular carcinoma in donation after circulatory death compared with donation after brain death: A systematic review and meta-analysis.

机构信息

Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China; NHC Key Laboratory of Combined Multi-Organ Transplantation, China; Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, China; Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, Zhejiang 310003, China.

出版信息

Ann Hepatol. 2024 May-Jun;29(3):101484. doi: 10.1016/j.aohep.2024.101484. Epub 2024 Feb 27.

DOI:10.1016/j.aohep.2024.101484

PMID:38417629

Abstract

INTRODUCTION AND OBJECTIVES

Due to organ shortages, liver transplantation (LT) using donation-after-circulatory-death (DCD) grafts has become more common. There is limited and conflicting evidence on LT outcomes using DCD grafts compared to those using donation-after-brain death (DBD) grafts for patients with hepatocellular carcinoma (HCC). We aimed to summarize the current evidence on the outcomes of DCD-LT and DBD-LT in patients with HCC.

MATERIALS AND METHODS

Online databases were searched for studies comparing DCD-LT and DBD-LT outcomes in patients with HCC and a meta-analysis was conducted using fixed- or random-effects models.

RESULTS

Five studies involving 487 (33.4%) HCC DCD-LT patients and 973 (66.6%) DBD-LT patients were included. The meta-analysis showed comparable 1-year [relative risk (RR)=0.99, 95%CI:0.95 to 1.03, p=0.53] and 3-year [RR=0.99, 95%CI:0.89 to 1.09, p=0.79] recurrence-free survival. The corresponding 1-year [RR=0.98, 95%CI:0.93 to 1.03, p=0.35] and 3-year [RR=0.94, 95%CI:0.87 to 1.01, p=0.08] patient survival and 1-year [RR=0.91, 95%CI:0.71 to 1.16, p=0.43] and 3-year [RR=0.92, 95%CI:0.67 to 1.26, p=0.59] graft survival were also comparable. There were no significant differences between the two cohorts regarding the tumor characteristics, donor/recipient risk factors and the incidence of post-operative complications, including acute rejection, primary non-function, biliary complications and retransplantation.

CONCLUSIONS

Based on the current evidence, it has been found that comparable outcomes can be achieved in HCC patients using DCD-LT compared to DBD-LT, particularly when employing good quality graft, strict donor and recipient selection, and effective surgical management. The decision to utilize DCD-LT for HCC patients should be personalized, taking into consideration the risk of post-LT HCC recurrence. (PROSPERO ID: CRD42023445812).

摘要

介绍和目的

由于器官短缺，使用捐赠后循环死亡（DCD）供体的肝移植（LT）变得更加普遍。与使用脑死亡后捐赠（DBD）供体的 LT 相比，使用 DCD 供体的 LT 在肝细胞癌（HCC）患者中的结局的相关证据有限且存在争议。我们旨在总结目前关于 HCC 患者使用 DCD-LT 和 DBD-LT 的结局的证据。

材料和方法

在线数据库中检索了比较 HCC 患者 DCD-LT 和 DBD-LT 结局的研究，并使用固定或随机效应模型进行了荟萃分析。

结果

纳入了 5 项研究，涉及 487 例（33.4%） HCC DCD-LT 患者和 973 例（66.6%） DBD-LT 患者。荟萃分析显示，1 年[相对风险（RR）=0.99，95%CI：0.95 至 1.03，p=0.53]和 3 年[RR=0.99，95%CI：0.89 至 1.09，p=0.79]无复发生存率相似。相应的 1 年[RR=0.98，95%CI：0.93 至 1.03，p=0.35]和 3 年[RR=0.94，95%CI：0.87 至 1.01，p=0.08]患者生存率以及 1 年[RR=0.91，95%CI：0.71 至 1.16，p=0.43]和 3 年[RR=0.92，95%CI：0.67 至 1.26，p=0.59]移植物生存率也相似。两组患者在肿瘤特征、供体/受体危险因素以及术后并发症（包括急性排斥反应、原发性无功能、胆道并发症和再次移植）的发生率方面没有显著差异。

结论

基于目前的证据，发现使用 DCD-LT 的 HCC 患者可以获得与 DBD-LT 相当的结局，尤其是在使用高质量供体、严格的供体和受体选择以及有效的手术管理时。对于 HCC 患者是否使用 DCD-LT 的决策应该个体化，考虑到 LT 后 HCC 复发的风险。（PROSPERO ID：CRD42023445812）。