Liver transplantation as a management of hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is one of the most common cancers worldwide and has a poor prognosis if untreated. It is ranked the third among the causes of cancer-related death. There are multiple etiologic factors that can lead to HCC. Screening for early HCC is challenging due to the lack of well specific biomarkers. However,early diagnosis through successful screening is very important to provide cure rate. Liver transplantation(LT) did not gain wide acceptance until the mid-1980 s,after the effective immunosuppression withcyclosporine became available. Orthotopic LT is the best therapeutic option for early,unresectable HCC. It is limited by both,graft shortage and the need for appropriate patient selection. It provides both,the removal of tumor and the remaining cirrhotic liver. In Milan,a prospective cohort study defined restrictive selection criteria known as Milan criteria(MC) that led to superior survival for transplant patients in comparison with any other previous experience with transplantation or other options for HCC. When transplantation occurs within the established MC,the outcomes are similar to those for nonmalignant liver disease after transplantation. The shortage of organs from deceased donors has led to the problems of long waiting times and dropouts. This has led to the adoption of extended criteria by many centers. Several measures have been taken to solve these problems including prioritization of patients with HCC,use of pretransplant adjuvant treatment,and living donor LT.

供肾移植前常规病理学评估对移植后早期肾功能的影响

目的 探讨供肾移植前常规活检常见的病理变化,以及病变对肾移植术后肾功能的影响.方法 回顾性分析2016年8月～2017年3月48例公民逝世后器官捐献（DCD）供者供肾肾移植前活检资料及供、受者的临床资料,在移植前对供者双侧肾脏进行活检并依据2016供肾Banff标准进行评分,评估供肾Banff评分对术后3个月内肾功能的影响.结果 供者48例,供肾96个,1例供者右肾先天未发育（未穿刺）,活检供肾95个（2条穿刺组织）,1例供者左肾弥漫性近端弓形动脉血栓形成放弃使用（右侧正常）,1例供者左肾重度小动脉玻璃样变（ah 3）放弃使用（右侧正常）,1对供肾重度间质纤维化（＞70％）放弃使用,1对供肾肾小球硬化比例高（＞30％）弃用.左肾组和右肾组在各项病理表现上比较,差异无统计学意义（P＞0.05）.除肾小球硬化（glomerulosclerosis,GS）比例外,肾间质纤维化的发病率为17％,肾小管萎缩的发病率为16％,肾间质炎的发病率为13％,动脉内膜纤维化的发病率为19％,小动脉内膜玻璃样变的发病率为28％,肾小球血栓的发病率为0％,急性肾小管损伤（AKI）的发病率为81％;供肾Banff评分小动脉内膜玻璃样变＞2分组与小动脉内膜玻璃样变≤2分组的受者相比,术后16天、1个月、3个月估算肾小球滤过率（eGFR）的差异有统计学意义（P＜0.05）;小动脉内膜玻璃样变＞2分组3个月终末血肌酐（t-Scr）为（152.5±47.38） μmol/L,小动脉内膜玻璃样变≤2分组的t-Scr为（122.08±36.57） μmol/L,差异有统计学意义（P＜0.05）;Banff评分总分＞3分组和总分≤3分组的受者相比,术后1个月、3个月eGFR的差异有统计学意义（P＜0.05）,总分≥3分组t-Scr为（146.18±44.55） μmol/L,总分＜3分组t-Scr为（115.27±30.67）μmol/L,差异有统计学意义（P＜0.05）.7例发生肾功能延迟恢复（DGF）,2例小动脉内膜玻璃样变＞2分且总分＞3分,其他5例小动脉内膜玻璃样变≤2分且总分≤3分,1例发生原发性移植肾无功能（PNF）.结论 供肾病理表现中血管病变和急性肾小管损伤较为常见;弥漫小动脉玻璃样变（小动脉内膜玻璃样变＞2）和Banff评分高（＞3分）的供肾肾移植后肾功能较差.