Ciria Ruben, Ivanics Tommy, Aliseda Daniel, Claasen Marco, Alconchel Felipe, Gaviria Felipe, Briceño Javier, Berardi Giammauro, Rotellar Fernando, Sapisochin Gonzalo
Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, University of Cordoba, IMIBIC, Cordoba, Spain.
Unit of Hepatobiliary Surgery, Hospital Quiron Salud, Cordoba, Spain.
Hepatology. 2025 Jun 1;81(6):1700-1713. doi: 10.1097/HEP.0000000000001129. Epub 2024 Oct 28.
Liver transplant (LT) for transplant oncology (TO) indications is being slowly adopted worldwide and has been recommended to be incorporated cautiously due to concerns about mid-long-term survival and its impact on the waiting list.
We conducted 4 systematic reviews of all series on TO indications (intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma [phCC]) and liver metastases from neuroendocrine tumors (NETs) and colorectal cancer (CRLM) and compared them using patient-level meta-analyses to data obtained from the United Network for Organ Sharing (UNOS) database considering conventional daily-practice indications. Secondary analyses were done for specific selection criteria (Mayo-like protocols for phCC, SECA-2 for CRLM, and Milan criteria for NET). A total of 112,014 LT were analyzed from 2005 to 2020 from the UNOS databases and compared with 345, 721, 494, and 103 patients obtained from meta-analyses on intrahepatic cholangiocarcinoma and phCC, and liver metastases from NET and CRLM, respectively. Five-year overall survival was 53.3%, 56.4%, 68.6%, and 53.8%, respectively. In Mantel-Cox one-to-one comparisons, survival of TO indications was superior to combined LT, second, and third LT and not statistically significantly different from LT in recipients >70 years and high BMI.
Liver transplantation for TO indications has adequate 5-year survival rates, mostly when performed under the selection criteria available in the literature (Mayo-like protocols for phCC, SECA-2 for CRLM, and Milan for NET). Despite concerns about its impact on the waiting list, some other LT indications are being performed with lower survival rates. These oncological patients should be given the opportunity to have a definitive curative therapy within validated criteria.
因对中长期生存及其对等待名单的影响存在担忧，全球范围内肝移植（LT）用于移植肿瘤学（TO）适应证的应用正在缓慢推广，且已被建议谨慎纳入。
我们对所有关于TO适应证（肝内胆管癌和肝门部胆管癌[phCC]）以及神经内分泌肿瘤（NETs）和结直肠癌肝转移（CRLM）的系列研究进行了4项系统评价，并使用患者水平的荟萃分析将其与从器官共享联合网络（UNOS）数据库中获取的考虑传统日常实践适应证的数据进行比较。针对特定选择标准（phCC的梅奥样方案、CRLM的SECA - 2以及NET的米兰标准）进行了二次分析。从2005年至2020年，对UNOS数据库中的112,014例肝移植进行了分析，并分别与从肝内胆管癌和phCC、NET和CRLM肝转移的荟萃分析中获得的345、721、494和103例患者进行比较。5年总生存率分别为53.3%、56.4%、68.6%和53.8%。在Mantel - Cox一对一比较中，TO适应证患者的生存率优于联合肝移植、二次肝移植和三次肝移植，且与70岁以上及高BMI受者的肝移植无统计学显著差异。
用于TO适应证的肝移植具有足够的5年生存率，多数情况下是在文献中可用的选择标准（phCC的梅奥样方案；CRLM的SECA - 2；NET的米兰标准）下进行的。尽管担心其对等待名单的影响，但其他一些肝移植适应证的生存率较低。这些肿瘤患者应在经过验证的标准范围内有机会接受确定性的治愈性治疗。
