无缺血肝移植减少肝移植后肝细胞癌复发的潜在作用  

The potential role of ischemia-free liver transplantation in reducing the recurrence of hepatocellular carcinoma after liver transplantation

作　　者：覃美婷 李嘉浩 但佳 赵强[1] 何晓顺[1] Qin Meiting;Li Jiahao;Dan Jia;Zhao Qiang;He Xiaoshun(Organ Transplant Center,The First Affiliated Hospital of Sun Yat-sen University,Guangdong Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院器官移植中心,广东广州510080

出　　处：《实用器官移植电子杂志》2024年第6期504-509,共6页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的本研究的目的在于评估无缺血肝移植(ischemia-free liver transplantation,IFLT)技术对于减少肝移植后肝细胞癌(hepatocellular carcinoma,HCC)复发的潜在效果,并与传统肝移植(conventional liver transplantation,CLT)的效果进行比较。方法采用回顾性队列研究方法纳入了2018年1月1日至2021年5月31日在中山大学附属第一医院接受肝移植的208例HCC患者,其中22例接受了IFLT,其余186例患者接受了CLT。患者根据手术方式不同被分为IFLT组和CLT组,比较两组的肿瘤粗复发率、术后早期肝功能指标、并发症发生率以及其他围手术期数据。主要终点为肿瘤复发,次要终点包括早期移植物功能障碍(early allograft dysfunction,EAD)、血清丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST)水平。结果IFLT组的无肿瘤复发生存期显著高于CLT组(P=0.037)。IFLT组患者的EAD发生率(4.5%)显著低于CLT组(26.3%,P=0.046)。IFLT组患者术后7 d内的血清ALT、AST峰值和总胆红素峰值均显著低于CLT组。结论IFLT技术通过维持肝移植物的血液和氧气供应,避免了缺血/再灌注损伤(ischemia-reperfusion injury,IRI),减少了HCC复发的风险,并改善了供肝质量。IFLT技术有望成为一种有效的策略,用于减少肝移植后HCC的复发,改善患者的长期预后。Objective The purpose of this study is to evaluate the potential effect of ischemia-free liver transplantation(IFLT)technology in reducing the recurrence of hepatocellular carcinoma(HCC)after liver transplantation,and to compare it with the outcomes of conventional liver transplantation(CLT).Methods We conducted a retrospective cohort study,including 208 HBV-HCC patients who underwent liver transplantation at the First Affiliated Hospital of Sun Yat-sen University from January 1,2018,to May 31,2021.Among them,22 cases received IFLT,and the remaining 186 patients received CLT.Patients were divided into IFLT and CLT groups based on the type of surgery they received,and the tumor recurrence rate,early postoperative liver function indicators,incidence of complications,and other perioperative data were compared between the two groups.The primary endpoint was tumor recurrence,and secondary endpoints included early allograft dysfunction(EAD),and serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels.Results The recurrence-free survival period in the IFLT group was significantly higher than that in the CLT group(P=0.037).The incidence of EAD in the IFLT group(4.5%)was significantly lower than that in the CLT group(26.3%,P=0.046).The peak serum ALT and AST levels,as well as the peak total bilirubin levels,were all significantly lower in the IFLT group compared to the CLT group within seven days postoperatively.Conclusion IFLT technology helps avoid ischemia-reperfusion injury(IRI)by maintaining the blood and oxygen supply to the liver graft,which reduces the risk of hepatocellular carcinoma(HCC)recurrence and improves the quality of the donor liver.IFLT is expected to become an effective strategy for reducing the recurrence of HCC after liver transplantation and improving patients'long-term prognosis.

关 键 词：缺血/再灌注损伤 无缺血肝移植 肝细胞癌复发 

分 类 号：R735.7[医药卫生—肿瘤]