Fukumitsu Ken, Ito Takashi, Kageyama Shoichi, Ogiso Satoshi, Anazawa Takayuki, Nagai Kazuyuki, Uchida Yoichiro, Ishii Takamichi, Hatano Etsuro
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, Kyoto, 606-8507, Japan.
Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-Cho, Nishigyo-Ku, Kyoto, Kyoto, 615-8256, Japan.
Int J Clin Oncol. 2025 Jul 5. doi: 10.1007/s10147-025-02820-3.
Liver transplantation (LT) has become widespread in recent years owing to advances in the elucidation of its pathogenesis, surgical procedures, and perioperative management. Historically, LT was only performed in patients with end-stage liver disease and certain malignancies, such as hepatocellular carcinoma, but its indications have recently been expanded to include unresectable perihilar cholangiocarcinoma (pCCA) and colorectal liver metastases (CRLM). In this review, we discuss the current status and future prospects of LT for these expanded indications. Perihilar cholangiocarcinoma and colorectal liver metastasis have poor prognoses if they cannot be surgically resected. For non-resectable pCCA, neoadjuvant chemoradiotherapy followed by LT has demonstrated improved survival, particularly under the Mayo Clinic protocol. Furthermore, LT for CRLM has received renewed interest following encouraging results from a Norwegian group showing a 5-year survival rate of > 80% with strict selection criteria. A recent randomized controlled trial further validated LT with chemotherapy as a promising option, demonstrating a significant survival advantage over chemotherapy alone. Both achieved favorable outcomes by implementing strict patient selection criteria and integrating LT as part of a multidisciplinary treatment approach that includes chemotherapy and radiation therapy. As transplant oncology continues to evolve, a multidisciplinary approach integrating transplant surgery, oncology, and hepatology is crucial for refining LT protocols for non-resectable pCCA and CRLM. Ongoing clinical trials and translational research are key to defining the role of LT in this expanding field, potentially establishing it as a standard therapy for selected cases of advanced hepatic malignancies.
近年来，由于在肝移植发病机制、手术操作及围手术期管理等方面的研究取得进展，肝移植（LT）已广泛开展。历史上，肝移植仅用于终末期肝病及某些恶性肿瘤患者，如肝细胞癌，但近来其适应证已扩大至不可切除的肝门部胆管癌（pCCA）和结直肠癌肝转移（CRLM）。在本综述中，我们讨论了肝移植在这些扩大适应证方面的现状及未来前景。如果肝门部胆管癌和结直肠癌肝转移无法手术切除，其预后较差。对于不可切除的pCCA，新辅助放化疗后行肝移植已显示出生存率提高，尤其是在梅奥诊所方案下。此外，挪威一组令人鼓舞的结果显示，严格选择标准下CRLM患者行肝移植5年生存率>80%，这使得肝移植治疗CRLM重新受到关注。最近一项随机对照试验进一步证实，肝移植联合化疗是一种有前景的选择，显示出比单纯化疗有显著的生存优势。通过实施严格的患者选择标准，并将肝移植作为包括化疗和放疗在内的多学科治疗方法的一部分，两者均取得了良好的效果。随着移植肿瘤学的不断发展，整合移植外科、肿瘤学和肝病学的多学科方法对于完善不可切除pCCA和CRLM的肝移植方案至关重要。正在进行的临床试验和转化研究是确定肝移植在这一不断扩大领域中作用的关键，有可能将其确立为某些晚期肝脏恶性肿瘤病例的标准治疗方法。
