Clinical Study Of Slavage Liver Transplantation For HCC Recurrence After Liver Resection And Clinical Study Of Monitoring CD4+Tcell-iATP Level In Liver Transplant Recipients

Aim To evaluate the clinical efficacy and factors that might affect the prognosis of salvage liver transplantation(SLT) for hepatocellular carcinoma(HCC) recurrence after liver resection; to evaluate the clinical effectiveness of Milan Criteria, UCSF Criteria, Up-to-seven Criteria for salvage liver transplantation(SLT) for hepatocellular carcinoma(HCC) recurrence after liver resection. Analyze the correlation between survival period after liver transplantation and the CD4+Tcell-i ATP levels, and also describe distribution characteristic of CD4+Tcell-i ATP levels among liver transplant recipients. Analyze the correlation between immunosuppressive therapy after liver transplantation and the CD4+Tcell-i ATP levels, and describe distribution characteristic of CD4+Tcell-i ATP levels among liver transplant recipients. Evaluate the validity of CD4+Tcell-i ATP levels for diagnosing infectious diseases after liver transplantation, and also describe distribution characteristic of CD4+Tcell-i ATP levels and variation tendency among liver transplant recipients.Method From June 1999 to June 2011, a total of 705 adult patients with HCC underwent orthotopic liver transplantation. Among these patients, 617 underwent primary liver transplantation(PLT), while the other 88 patients underwent SLT after primary liver curative resection due to intrahepatic recurrence. Statistically analyze the operative characteristics, survival, and the effect of pathologic features to prognosis of salvage liver transplantation and analyze the difference and the consistency of survival rate after liver transplantation between the PLT and SLT group, according to Milan Criteria, UCSF Criteria, Up-to-seven Criteria. A total number of 273 patients who underwent liver transplantation with long-term stable survival of follow-up were collected in the research, from 2010 July to 2012 October in our center. We use the Cylex Immu Know Assay to detect the CD4+Tcell-i ATP level of the blood sample, and analyze the CD4+Tcell-i ATP level according to different survival periods, retrospectively, and analyze the CD4+Tcell-i ATP level according to different Immunosuppressive therapy protocols, retrospectively.Result The mean age of the patients underwent SLT was 52.4±9.2 years old(range 26.8-74.3) with a median follow up of 39.2 months, mean operating time was 10.76±3.05 hours, mean blood loss was 3254.6±2809.3ml; the post transplant 0.5-,1-, 3-,and 5-year overall survival rates for salvage liver transplantation were 87.5%, 75.0%, 56.7%, 49.4%,; the factors such as Edmondson grade, TNM stage, invasion of hepatic vein and portal vein significantly affect the prognosis of SLT. For the patients underwent PLT, Milan Criteria, UCSF Criteria, Up-to-seven Criteria show the consistency to evaluate the long-term survival after liver transplantation, with the 5-year survival rate 76.2%,75.5%,73.4%. For SLT patients, Milan Criteria, UCSF Criteria show the consistency to evaluate the long-term survival after liver transplantation, with the 5-year survival rate 83.1%, 72.6%. The 5-year survival rate is only 49.9% meeting Up-to-seven Criteria, which is 49.4% beyond this criteria, with no effectiveness. There is a significantly difference of CD4+Tcell-i ATP levels among the survival recipient groups located in different survival period after liver transplantation. Extremely high CD4+Tcell-i ATP levels were prone to appear especially within the first 3 months after surgery. There is a significantly difference of CD4+Tcell-i ATP levels among the survival recipient groups receiving different immunosuppressive therapy protocols after liver transplantation. The CD4+Tcell-i ATP levels of FK506 group and FK506+Pred group were higher than that of FK506+MMF group, FK506+MMF+Pred group and Rapa group, with significant difference; the CD4+Tcell-i ATP level of with MMF group was much lower than without MMF group. There is a significantly difference of CD4+Tcell-i ATP levels between the infection group and stable group located in same period after liver transplantation.Conclusion Salvage liver transplantation for HCC recurrence after liver resection does not increase the risk of operations or impair long-term survival following transplant; Milan Criteria, UCSF Criteria show effective consistency for selection of SLT for HCC recurrence after liver resection, while Up-to-seven criteria do not. For SLT, a three-dimensional variables model should be collected to overall evaluate the prognosis of SLT, including HCC data of primary liver resection and before SLT for HCC recurrence, and also the interval term from primary liver resection to HCCrecurrence. In the era of organ shortage, SLT is a effective treatment strategy for patients with HCC recurrence after liver resection. CD4+Tcell-i ATP can be used as a monitoring biomarker for diagnosing infectious disease after liver transplantation. There is a relationship between distribution characteristics of CD4+Tcell-i ATP level and survival period after liver transplantation. There is a relationship between distribution characteristics of CD4+Tcell-i ATP level and immunosuppressive therapy protocol after liver transplantation, the application of MMF and Rapa reduce the CD4+Tcell-i ATP level most significantly.