A Comparison of Outcomes between Liver Transplant Recipients in China and those in Taiwan

Teng-Wei Chen ； Chih-Yung Yu ； Heng-Cheng Chu ； De-Chuan Chan ； Guo-Shiou Liao ； Chung-Bao Hsieh

《Journal of Medical Sciences》 33卷6期 (2013/12) Pp. 311-319

https://doi.org/10.6136/JMS.2013.33(6).311

並列摘要

Background: The outcome of liver transplantation in Taiwan and overseas has not been compared directly. We investigated differences in outcomes between liver transplant recipients in China and those in Taiwan. Materials and Methods: Ninety-two patients who underwent liver transplantation in China and were subsequently being followed at the Tri-Service General Hospital (TSGH; China group; CG) were compared with 107 patients who received transplants at TSGH (Taiwan group; TG). Donor and recipient characteristics, complications, and survival were analyzed. Survival was calculated using the Kaplan-Meier method, and univariate analysis was tested by the log-rank test. Then, regression analysis was performed using the Cox proportional hazard model. Results: The number of patients with hepatocellular carcinoma (HCC) beyond the Milan and University of California, San Francisco criteria was significantly higher in the CG than in the TG. The rates of HCC recurrence, intrahepatic biliary strictures, and mortality were also higher in the CG than in the TG. Univariate analysis revealed significant differences in 8 parameters between survivors and non-survivors, and Cox regression analysis further identified psychosocial problems, post-transplant de novo malignancy, HCC recurrence, and graft failure as mortality predictors. The overall survival rate was significantly higher in the TG than in the CG, with the former group showing a trend of greater mean survival duration. However, differences in survival were not significant after adjusting for risk factors. Conclusion: The outcomes of patients receiving livers donated after cardiac death may be comparable; however, patients with advanced HCC should not seek transplantation without appropriate pre-transplant tumor treatments.

並列關鍵字

liver transplantation ； survival ； brain death ； donation after cardiac death ； down-stage therapy

參考文獻

Ravaioli M, Ercolani G, Cescon M, Vetrone G, Voci C, Grigioni WF, D'Errico A, Ballardini G, Cavallari A, Grazi GL. Liver transplantation for hepatocellular carcinoma: Further consideration on selection criteria. Liver Transpl 2004;10:1195-1202, doi: 10.1002/ lt.20239.

Ringe B, Strong RW. The dilemma of living liver donor death: to report or not to report? Transplantation 2008;85:790-793, doi: 10.1097/TP.0b013e318167345e.

Fan ST, Wang H, Lam BK. Follow-up of Chinese liver transplant recipients in Hong Kong. Liver Transpl 2009;15:544-550, doi: 10.1002/lt.21720.

Dindo D, Demartines N, Clavien PM. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.

Muiesan P, Girlanda R, Jassem W, Melendez HV, O'Grady J, Bowles M, Rela M, Heaton N. Singlecenter experience with liver transplantation from controlled non-heart beating donors: a viable source of grafts. Ann Surg 2005;242:732-738.