| [Objective]（1）To discuss the efficacy and prognosis of liver cancer liver transplant patients in the Center by comparing the occurrence and survival rate of postoperative complications in patients with liver cancer liver transplantation and patients with benign end-stage liver disease;（2）to explore the effect of preoperative descending treatment on postoperative complications and short-term survival rate;（3）to summarize the experience of recurrence prevention and treatment of liver cancer liver transplantation.[Methods] A retrospective analysis was performed on the clinicopathological data of 125 liver transplantation patients admitted to the Organ Transplantation Center of the First Affiliated Hospital of Anhui Medical University from February 2015 to September 2021 in the second Ward of department of Hepatobiliary and Pancreatic Surgery.（1）According to postoperative pathological results,all patients were divided into liver transplantation group（n=27）for liver cancer and liver transplantation group（n=98）for benign end-stage liver disease.Donor,recipient and perioperative data of the two groups were collected,and the difference between the two groups was compared by univariate analysis.Kaplan-meier method was used to calculate the overall 1-year and 3-year cumulative survival rate of the recipients,and log-rank test was used to compare the survival rate between the two groups.（2）According to whether the liver cancer liver transplantation group received the hypothetical treatment before the operation,the liver cancer liver transplant group was further divided into the group receiving the descending phase treatment and the group that did not receive the descending phase treatment,and the postoperative complication rate and short-term survival rate of the two groups were compared;（3）Analyze the series of cases of primary liver cancer liver transplantation in this group,and conduct preliminary discussion on the screening criteria of liver cancer liver transplant recipients,the application of down-phase therapy during waiting period,and the comprehensive prevention and treatment of liver cancer recurrence after liver transplantation.[Results] The overall 1-year and 3-year survival rates of 125 patients were 84.8%and 74.05%.The 1-year and 3-year overall survival rates of liver transplantation group were 77.8% and 70.0%,while the 1-year and 3-year overall survival rates of benign end-stage liver disease group were 86.3% and 79.9%.Univariate analysis and log-rank test showed no significant difference in survival rates between the two groups（P>0.05）.Liver transplantation was successfully performed in all 27 patients with primary hepatocellular carcinoma（HCC）,of which 25 patients underwent primary liver transplantation,and 2 patients underwent hepatectomy first,followed by salvage liver transplantation due to tumor.Among HCC patients undergoing liver transplantation,18 patients（18/27,66.7%）received down-stage treatment during the waiting period,including 6 patients receiving TACE alone,5 patients receiving ablation alone（including RFA or MWA）,4 patients receiving TACE combined with ablation,and 3 patients receiving other treatments（including 1patient receiving lomvaritinib alone）.TACE combined with RFA,MWA,Sorafenib,ramvaritinib and PD-1 inhibitor in 1 case,and TACE combined with RFA,ramvaritinib and PD-1 inhibitor in 1 case).The incidence of early postoperative serious complications was 25.9%（7/27）.A total of 7 cases（7/27,25.9%）died during the follow-up period,and 6 cases（6/27,22.2%）died in the early postoperative period（<3months）,including 2 cases of multiple organ failure caused by sepsis,1 case of acute rejection after transblood liver transplantation,1 case of postoperative fatal immune injury caused by the use of PD-1 before transplantation,and 1 case of primary liver transplantation failure.Graft versus host disease（GVHD）: 1 case;One patient（1/27,3.70%）died long term（>3months）after operation,which was caused by portal venous hypertension and digestive tract hemorrhage caused by extensive portal venous thrombosis.2 patients（2/27,7.4%）had tumor recurrence after transplantation,including 1 case of intrahepatic recurrence and 1 case of intrahepatic recurrence with pulmonary metastasis.The recurrence patients were still alive with tumor after radiofrequency ablation and adjusting immunosuppressive regimen,and the remaining 18 recipients were tumorfree and had a good prognosis.[Conclusion]（1）Liver transplantation is a radical surgical treatment for primary liver cancer,preoperative full assessment and strict grasp of the screening criteria for liver cancer liver transplantation,the current stage of liver transplantation guidance of UCSF standards for primary liver cancer can achieve a good prognosis;（2）waiting for the liver transplantation period to receive descending treatment has no significant impact on the occurrence of postoperative complications and overall survival,the selection of appropriate hypotherapy regimen can delay tumor progression,but the use of immune checkpoint inhibitors should be carefully considered;（3）Overall survival of patients can be improved by individualized immunosuppressive regimen,regular follow-up and monitoring,and active treatment of liver cancer recurrence after transplantation. |
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