[Liver transplantation for patients with hepatitis B/C virus cirrhosis or hepato cellular carcinoma].
The outcome of liver transplantation for patients with hepatitis B/C virus (HBV/HBC) cirrhosis or with hepatocellular carcinoma(HCC) was deemed pessimistic until the early 1990s due to the high rate of recurrence and mortality. However, with the advent of new antiviral agents and strict adherence transplant indications, the results of liver transplantation in patients with these disease have improved progressively. Coadministration of lamivudine and anti-HBV immunoglobulin, and of interferon and ribavirin inhibits the recurrence of hepatitis B and hepatitis C, respectively. Excluding HCC patients with extrahepatic or lymph node metastasis, vascular invasion, a single lesion more than 5 cm in diameter, or multiple lesions more than 3 cm in diameter, the 5-year patient survival rate has improved from 30% to 85%, with a disease-free survival rate of more than 90%. However, the development of lamivudineresistant mutants after prolonged use of the agent needs to be overcome, possibly by new antiviral agents such as adefovir. In addition, to expand the current limited transplant indications for HCC, the efficacy of perioperative anticancer treatment and the importance of molecular diagnosis of circulating hepatoma cells must be determined in future.
Todo
Satoru
S
Hokkaido University School of Medicine, Department of General Surgery.
Furukawa
Hiroyuki
H
Matsushita
Michiaki
M
Shimamura
Tsuyoshi
T
Jin
Men-Bong
MB
Suzuki
Tomomi
T
Taniguchi
Masahiko
M
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006509:Hepatitis B; D006526:Hepatitis C; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome