Single-center Clinical Analysis Of Liver Transplantation For Primary Hepatocellular Carcinoma

Objective:By analyzing the clinical data and pathological results of 89 liver transplantation patients in the Liver Transplantation Center of the First Hospital of Shanxi Medical University from 2020.04 to 2022.11 retrospectively,this study was designed to compare the survival rate and the occurrence of serious postoperative complications between patients with liver cancer and patients with benign liver diseases,discuss the efficacy and prognosis of liver transplantation for primary hepatocellular carcinoma,evaluate the safety and effectiveness of preoperative anti-tumor therapies,summarize the experience and finally make contributions to the research of selection and perioperative management of liver transplant recipients with liver cancer.Methods:(1)All patients were divided into liver cancer group and benign liver diseases group according to the pathological results after information gathering.The differences between the two groups were compared by univariate analysis,and their postoperative survival was described by Kaplan-Meier curve and Log-rank test.(2)The occurrence of serious postoperative complications was compared between patients with liver cancer and patients with benign liver diseases.(3)The patients of liver cancer group were divided into preoperative therapy group and preoperative observation group according to whether they had received preoperative anti-tumor therapies,of whom the differences would be compared subsequently.Then we divided the patients with liver cancer again according to whether they measured up to UCSF criteria and compared the differences of the two groups.(4)Finally,the global analysis of clinical characteristics of liver transplantation patients with primary hepatocellular carcinoma in the Center was performed,and the experience of diagnosis and treatment were summarized.Results:(1)Among 89 patients undergoing liver transplantation,24 patients were diagnosed with primary hepatocellular carcinoma,of which 70.8% measured up to UCSF criteria.(2)There were 7 patients dead and 3 patients developing new-onset malignant tumor of whom 2 cases had died in benign liver diseases group during the follow-up period,and there was only one patient with tumor recurrence after operation in liver cancer group.The3-month,1-year and 2-year overall survival rates of all patients in this study were 95.4%,91.1% and 91.1%.The 3-month,1-year and 2-year overall survival rates of benign liver diseases group were 93.7%,87.5% and 87.5%,while there were no deaths in liver cancer group.(3)In addition to the gender composition,there was no statistical difference between liver cancer group and benign liver diseases group in terms of therapy time in ICU,total duration of hospitalization,the overall survival rates after transplantation,the incidence of serious postoperative complications and so on.(4)There was no statistical difference between preoperative therapy group and preoperative observation group in terms of therapy time in ICU and the incidence of serious postoperative complications,but the patients with preoperative anti-tumor treatments accounting for 54.2% of liver cancer group needed shorter total duration of hospitalization.There was also no statistical difference in efficacy and prognosis whether they measured up to UCSF criteria.Conclusion:Liver transplantation is an effective and thorough treatment for primary hepatocellular carcinoma,especially for the patients with liver function decompensation and inapplicability of surgical resection or ablation.Adopting the UCSF criteria to guide the screening of liver cancer recipients,taking descending treatment and bridging therapy to delay tumor progression and reduce tumor loading,developing individualized immunosuppressive regimen to maintain the balance of systemic immune status and performing multidisciplinary therapeutic strategies to cope with postoperative tumor recurrence could effectively improve the postoperative survival,and finally achieve the similar efficacy and prognosis to liver transplantation for benign liver diseases.