肝细胞癌的活体供肝肝移植
Living Donor Liver Transplantation for Hepatocellular Carcinoma.
作者信息
Nabi Prithiviraj, Rammohan Ashwin, Rela Mohamed
机构信息
The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
出版信息
J Clin Exp Hepatol. 2024 Nov-Dec;14(6):101933. doi: 10.1016/j.jceh.2024.101933. Epub 2024 Jul 14.
Liver transplantation (LT) offers the best chance of cure for patients with hepatocellular carcinoma (HCC), as it addresses simultaneously the underlying disease and the tumour. The Milan criteria has been the standard for over 3 decades in selecting patients with HCC who will benefit from LT. While, early studies showed higher recurrence rates for HCC following living donor LT (LDLT), recent series, especially in the past decade have shown LDLT to have equal oncological outcomes as compared to deceased donor LT (DDLT) for HCC, even in patients beyond Milan criteria. Further, the intention to treat analysis data suggests that LDLT may actually provide a survival advantage. In the west, factors such as improved outcomes on par with DDLT, ability to time the LT etc., have led to a steadily increased number of LDLTs being performed for this indication. On the other hand, in the east, given its geo-socio-cultural idiosyncrasies, LDLT has always been the predominant form of LT for HCC, consequently resulting in an increased number of LDLTs being performed for this indication across the world. While LDLT in HCC has its distinctive advantages compared to DDLT, the double equipoise of balancing the donor risk with the recipient outcomes has to be considered while selecting patients for LDLT. There have been several advances including the application of downstaging therapies and the use of biological markers, which have further helped improve outcomes of LDLT for this indication. This review aims to provide an update on the current advances in the field of transplant oncology related to the practice of LDLT in HCC.
肝移植(LT)为肝细胞癌(HCC)患者提供了最佳的治愈机会,因为它能同时解决潜在疾病和肿瘤问题。米兰标准在超过30年的时间里一直是选择能从LT中获益的HCC患者的标准。虽然早期研究显示活体供肝肝移植(LDLT)后HCC的复发率较高,但最近的系列研究,尤其是在过去十年中,已表明对于HCC患者,LDLT与尸体供肝肝移植(DDLT)相比具有相同的肿瘤学结局,即使是超出米兰标准的患者也是如此。此外,意向性治疗分析数据表明LDLT实际上可能具有生存优势。在西方,与DDLT相当的改善结局、安排LT时间的能力等因素,导致针对该适应症进行的LDLT数量稳步增加。另一方面,在东方,鉴于其地理社会文化特点,LDLT一直是HCC肝移植的主要形式,因此导致全球针对该适应症进行的LDLT数量增加。虽然与DDLT相比,HCC的LDLT有其独特优势,但在选择LDLT患者时,必须考虑平衡供体风险与受体结局的双重权衡。已经有了一些进展,包括降期治疗的应用和生物标志物的使用,这些进一步有助于改善该适应症的LDLT结局。本综述旨在提供与HCC中LDLT实践相关的移植肿瘤学领域当前进展的最新情况。