Fisher RA, Kulik LM, Freise CE, Lok AS, Shearon TH, Brown RS Jr, Ghobrial RM, Fair JH, Olthoff KM, Kam I, Berg CL; A2ALL研究组.
外科，弗吉尼亚大学附属医院，弗吉尼亚联邦大学，里士满，弗吉尼亚，美国

我们在106例患肝硬化和肝癌的移植候选人中进行了关于肝细胞癌复发的调查。1998年1月至2003年2月期间，在9个研究中心进行的成人-成人活体肝移植群组研究（A2ALL）中，这些患者的评估结果均为存在潜在的活体肝移植供体。

在58例活体肝移植和34例尸体肝移植受体中，我们应用Cox回归模型来比较捐赠者接受评估的时间、从移植到死亡或到肝癌复发的时间。活体肝移植和尸体肝移植患者的平均年龄和MELD分数都相似（年龄： 55 vs. 52 years，p = 0.21； MELD：13 vs. 15，p = 0.08）。

相对尸体肝移植受体来说，活体肝移植受体从等待到移植的时间较短（平均160天vs. 469天，p < 0.0001），肝细胞癌的三年复发率更高（29% vs. 0%，p = 0.002 ）；但是，死亡率或复发率却没有区别。与没有进行活体肝移植手术的患者相比，活体肝移植受体发生死亡的风险相对较低（p=0.03）。以活体肝移植治疗肝细胞癌，由于较高的肝癌复发率而受到限制。

Hepatocellular carcinoma recurrence and death following living and deceased donor liver transplantation.
Fisher RA, Kulik LM, Freise CE, Lok AS, Shearon TH, Brown RS Jr, Ghobrial RM, Fair JH, Olthoff KM, Kam I, Berg CL; A2ALL Study Group.
Department of Surgery, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA, USA.

We examined mortality and recurrence of hepatocellular carcinoma (HCC) among 106 transplant candidates with cirrhosis and HCC who had a potential living donor evaluated between January 1998 and February 2003 at the nine centers participating in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL).

Cox regression models were fitted to compare time from donor evaluation and time from transplant to death or HCC recurrence between 58 living donor liver transplant (LDLT) and 34 deceased donor liver transplant (DDLT) recipients. Mean age and calculated Model for End-Stage Liver Disease (MELD) scores at transplant were similar between LDLT and DDLT recipients (age: 55 vs. 52 years, p = 0.21; MELD: 13 vs. 15, p = 0.08).

Relative to DDLT recipients, LDLT recipients had a shorter time from listing to transplant (mean 160 vs. 469 days, p < 0.0001) and a higher rate of HCC recurrence within 3 years than DDLT recipients (29% vs. 0%, p = 0.002), but there was no difference in mortality or the combined outcome of mortality or recurrence. LDLT recipients had lower relative mortality risk than patients who did not undergo LDLT after the center had more experience (p = 0.03). Enthusiasm for LDLT as HCC treatment is dampened by higher HCC recurrence compared to DDLT.

Am J Transplant. 2007 Jun;7(6):1601-8. Links
PMID: 17511683 [PubMed - indexed for MEDLINE]

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