Abstract:

ObjectiveTo analyze the independent risk factors for achieving a textbook outcome （TO） inliver transplant （LT） surgery for patients with hepatocellular carcinoma. MethodsRetrospective analysis of clinical diagnosis and treatment data of patients with HCC who underwent LT in the Liver Transplantation Department of Sun Yatsen Memorial Hospital， Sun Yat-sen University from June 2019 to December 2022 was performed. A total of 134 patients were included， including 124 males and 10 females， with a median age of 54（47 ～ 60） years. According to whether TO was achieved， they were divided into the TO group （n ＝ 41） and the non-TO group （n＝ 93）. Univariate and multivariatelogistic regression analyses were used to identify independent factors affecting TO. ResultsApproximately one-third（30.6%） of hepatocellular carcinoma patients achieved tumor obliteration （TO） after liver transplantation （LT）. Multivariate analysis showed that preoperative bilirubin ≥ 54.1 mmol/L （OR ＝ 9.75，95% CI ＝ 2.01 ～ 47.28，P ＝ 0.005） and biliary stasis in donor liver （OR ＝ 2.93，95% CI ＝ 1.21 ～ 7.13，P ＝ 0.018） were independent risk factors for achieving TO. Further analysis revealed no statistical difference in long-term survival rates between the TO group and non-TO group （χ2 ＝ 1.127，P ＝ 0.288）. ConclusionPreoperative high serum bilirubin and cholestasis in the donor liver areindependent risk factors for achieving TO after liver transplantation in patients with hepatocellular carcinoma. Currently， no differences have been found in the long-term survival rates between different groups. As a comprehensive indicator of shortterm prognosis，TO can be used to compare the quality of nursing among different centers after liver transplantation.

Key words:

Textbook outcome, Hepatocellular carcinoma, Liver transplantation sequencing

摘要：

目的 分析肝细胞癌（hepatocellular carcinoma，HCC）患者行肝移植（liver transplantation， LT）手术后达成教科书式结局（textbook outcome， TO）的独立影响因素。方法 回顾性分析 2019 年 6 月— 2022 年 12 月在中山大学孙逸仙纪念医院肝移植科行 LT 的肝细胞癌患者临床诊疗数据。共纳入 134 例患者，其中男性 124 例， 女性 10 例，年龄为 54（47 ～ 60）岁。根据是否达成 TO 分为 TO 组（n ＝ 41）和非 TO 组（n ＝ 93）。单因素和多因素 Logistic 回归分析 TO 的独立影响因素。结果 约 1/3（30.6%）的肝细胞癌患者在 LT 后实现了 TO。多变量分析表明，术前胆红素≥ 54.1 mmol/L （OR ＝ 9.75，95% CI ＝ 2.01 ～ 47.28，P ＝ 0.005）及供肝胆汁淤积（OR ＝2.93，95% CI ＝ 1.21 ～ 7.13，P ＝ 0.018）是实现 TO 的独立影响因素。进一步分析发现 TO 组和非 TO 组之间的远期生存率并无统计学差异（χ2 ＝1.127，P ＝ 0.288）。结论 术前血清高胆红素及供肝胆汁淤积是肝细胞癌患者肝移植手术后达成 TO 的独立影响因素，目前尚未发现不同组别之间的远期生存率之间存在差异。TO 作为一项短期预后的综合指标，能够比较不同中心之间肝移植手术及围手术期护理质量。 

关键词:

教科书结局 , 肝细胞癌 , 肝移植