Malik Abdullah K, Mahendran Balaji, Lochan Rajiv, White Steven A
Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
NIHR Blood and Transplant Research Unit, Newcastle University, Newcastle Upon Tyne, UK.
Indian J Surg Oncol. 2024 May;15(Suppl 2):255-260. doi: 10.1007/s13193-023-01827-4. Epub 2023 Oct 16.
Transplantation represents the most radical locoregional therapy through removal of the liver, associated vasculature and locoregional lymph nodes, and replacing it with an allograft. Recent evidence has demonstrated that transplantation for unresectable CRLM is feasible with acceptable post-transplant outcomes in a highly selected cohort of patients. Controversy exists regarding whether transplantation is an appropriate treatment for such patients, due to concerns regarding disease recurrence in the transplanted graft in an immunosuppressed recipient along with utilising a donor liver which are in short supply. Expanding the indications for liver transplantation may also limit access for other patients with end-stage liver disease having ethical implications due to the effect of increasing the waiting list. In this review, we summarise the current evidence for liver transplantation in patients with nonresectable CRLM and highlight unresolved controversies and future directions for this type of treatment.
肝移植是最彻底的局部区域治疗方法，通过切除肝脏、相关血管和局部区域淋巴结，并用同种异体移植物进行替代。最近的证据表明，在经过严格筛选的患者队列中，对不可切除的结直肠癌肝转移（CRLM）进行肝移植是可行的，且移植后的结果可以接受。对于此类患者，肝移植是否为合适的治疗方法存在争议，这是因为担心免疫抑制受者移植的移植物中疾病复发，以及供肝短缺的问题。扩大肝移植的适应症可能还会限制其他终末期肝病患者的肝移植机会，这会因增加等待名单而产生伦理问题。在本综述中，我们总结了目前不可切除CRLM患者肝移植的证据，并强调了此类治疗中尚未解决的争议和未来方向。
