Batı Imam Bakır, Tüysüz Umut
Department of Liver Transplant Surgery, Faculty of Medicine, Acıbadem University, Istanbul, Türkiye.
Department of Liver Transplant Surgery, Şişli Etfal Hamidiye Training and Research Hospital, Istanbul, Türkiye.
Front Oncol. 2024 Aug 22;14:1419740. doi: 10.3389/fonc.2024.1419740. eCollection 2024.
Hepatocellular cancer (HCC) is the most common primary liver cancer with increasing incidence. Liver transplantation (LT) has been accepted as main curative liver cancer treatment. The effectiveness of LDLT as opposed to Deceased Donor Liver Transplant (DDLT) for patients with HCC is still controversial. There is limited data comparing the long-term outcomes of patients undergoing LDLT or DDLT for HCCs that do not meet the Milan criteria.
We aimed to compare the perioperative and survival outcomes of LDLT with DDLT in HCC patients.Patients underwent LT between January 2012 and December 2020 were retrospectively analyzed. There were 137 patients who met the UCSF criteria. Of these, 75 patients received LDLT and 62 patients DDLT.The primary end points in the present study were oncologic outcomes such as the recurrence rate, disease-free survival (DFS) and overall survival (OS) of LDLT and DDLT in patients with HCC.
PET-CT SUVmax value, the amount of erythrocyte solution (ES) as blood transfusion of red cells given and the tumor recurrence rate were significantly higher among the deceased patients recurrence, ES, PET-CT SUVmax value and tumor differentiation had significant effects on survival. In the multivariate reduced model, cox regression analysis showed significant effects of recurrence, ES, locoregional treatment response and PET-CT on survival.Albeit not significant, the one-year recurrence rate in the LDLT was similar to that in the DDLT, three- and five-year recurrence rates were higher in DDLT compared to LDLT.
There is less chance of cold ischemia time and better-quality grafts with minimal fatty changes, lower recurrence rates and similar survival rates can be achieved in LDLT compared to DDLT.
肝细胞癌（HCC）是最常见的原发性肝癌，发病率呈上升趋势。肝移植（LT）已被公认为肝癌的主要根治性治疗方法。对于HCC患者，活体肝移植（LDLT）与尸体供肝肝移植（DDLT）相比的有效性仍存在争议。比较不符合米兰标准的HCC患者接受LDLT或DDLT的长期结局的数据有限。
我们旨在比较HCC患者中LDLT与DDLT的围手术期和生存结局。对2012年1月至2020年12月期间接受LT的患者进行回顾性分析。有137例患者符合加州大学旧金山分校（UCSF）标准。其中，75例患者接受了LDLT，62例患者接受了DDLT。本研究的主要终点是肿瘤学结局，如HCC患者中LDLT和DDLT的复发率、无病生存期（DFS）和总生存期（OS）。
在死亡患者中，PET-CT的SUVmax值、作为红细胞输血给予的红细胞悬液（ES）量和肿瘤复发率显著更高，ES、PET-CT的SUVmax值和肿瘤分化对生存有显著影响。在多变量简化模型中，cox回归分析显示复发、ES、局部区域治疗反应和PET-CT对生存有显著影响。尽管不显著，但LDLT的一年复发率与DDLT相似，DDLT的三年和五年复发率高于LDLT。
与DDLT相比，LDLT发生冷缺血时间的机会较少，移植物质量更好，脂肪变最小，复发率较低，生存率相似。
