Cumulative survival 1993 2009 3 1993 2009 83

中国大陆良、恶性疾病肝移植生存率比较 Cumulative survival (%) (1993 – 2009. 3) (1993 – 2009) 83. 8 % 78. 8% 76. 1% 76. 7 % 71. 6 % Benign (51. 8%) 55. 8 % HCC account for 5 -y Survival Beyond Milan 49. 2 % Malignant (48. 2%) Benign diseases vs Malignant 50% diseases: P Log rank < 0. 001 50% Survival time (month) 欧美仅5 -10％为肝癌

我所肝癌肝移植的结果 Cumulative and disease-free survival (2001~2009) n= 586 Cumulative survival 1 -year: 84. 2% 3 -year: 68. 3% 5 -year: 65. 5% n= 586 Disease-free survival 1 -year: 79. 8% 3 -year: 72. 9% 5 -year: 65. 4%

我所符合Milan标准肝癌肝移植的结果 Cumulative and disease-free survival (2001~2009) n= 257 Cumulative survival 1 -year: 89. 0% 3 -year: 80. 2% 5 -year: 80. 2% n= 257 Disease-free survival 1 -year: 91. 6% 3 -year: 88. 5% 5 -year: 84. 5%

肝癌肝移植适应证的选择 Authors n 筛选标准 5 y-OS Mazzaferro, NEJM 1996 Milan 标准 48 Single＜ 5 cm, 3 nodles ＜ 3 cm 74%(4 y) Bismuth, Semin Liver Dis, 1999 45 Single＜ 3 cm, 3 nodles ＜ 3 cm 74% Llovet, Hepatology 1999 79 Single＜ 5 cm 75% Yao, Hepatology 2001 UCSF 64 Single＜ 6. 5 cm, 3 nodles ＜ 4. 5 cm 73% Mazzaferro, Lancet Oncol 2009 1556 Up-to-seven, without microvascular invasion 71. 2% 适合中国国情？

雷帕霉素不增加术后肝动脉栓塞发生率 利于肝癌肝移植病人的长期存活 美国SRTR的数据 Sirolimus 5 y-OS P On (n=109) 83. 1% ＜ 0. 05 Off (n=2382) 68. 7% Toso C, et al. Hepatology, 2010, 51: 1237

机体免疫功能监测的新方法—— Cylex® 免疫细胞功能监测 孵化 15 -18 小时 磁性分离出CD 4细胞 淋巴细胞刺激w/PHA ATP ATP 细胞溶解，释放出ATP “In 洗液 ATP 反应物探测 Luminometer 测量光强度 Vitro CMI: Rapid Assay for Measuring Cell-Mediated Immunity”, CRC Press, 2002

Cylex®免疫细胞功能监测可用于肝癌肝 移植术后排异、感染的监测 P＜ 0. 05 594± 110 209± 59 stable 60± 25 rejection infection

肝内复发的治疗 TACE+索拉非尼 Baseline Follow-up 6 months

Thanks