胆道癌に対する肝移植  [in Japanese] Liver Transplantation for Cholangiocarcinoma  [in Japanese]

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Author(s)

    • 吉住 朋晴 Yoshizumi Tomoharu
    • 九州大学大学院消化器・総合外科 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
    • 調 憲 Shirabe Ken
    • 九州大学大学院消化器・総合外科 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
    • 前原 喜彦 Maehara Yoshihiko
    • 九州大学大学院消化器・総合外科 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University

Abstract

胆道癌に対する肝移植の良好な成績が欧米を中心に報告されつつある.歴史的に胆道癌に対する肝移植は,移植後早期に再発し予後不良で,胆道癌は肝移植の相対的禁忌とされてきた.しかし,最近の報告では症例の厳密な選択は必要であるが,術前補助化学放射線療法と肝移植により,移植後5年生存率は70%前後と他疾患のものと遜色ない.我が国では慢性的な脳死ドナー不足から,肝癌ではミラノ基準内のみが脳死肝移植の適応とされており,胆管癌に対して肝移植を施行する場合,生体肝移植が必要である.原発性硬化性胆管炎に胆管癌を合併する事が多いが,生体肝移植後は脳死肝移植に比べ原発性硬化性胆管炎の再発が多く,胆管癌に対して生体肝移植を積極的に行うべきか,今後議論を重ねる必要がある.本稿では,胆道癌に対する肝移植に関する最近の欧米からの報告のレビューと自験例の検討から,胆道癌の治療としての肝移植の位置づけについて概説する.

Neoadjuvant chemoradiotherapy followed by liver transplantation (LT) is reported as an effective treatment for patients with unresectable hilar cholangiocarcinoma, with 5-year survival is around 70%. Historically, liver transplantation alone is equally poor treatment in multiple reports. Success requires careful patient selection to exclude patients with advanced disease and regional lymph node metastasis that are destined to develop distant metastasis. Due to cadaveric donor shortage, cadaveric liver transplantation is permitted for liver cancer within Milan criteria in Japan. Therefore, living donor liver transplantation (LDLT) is required for patients with known unresectable hilar cholangiocarcinoma. Primary sclerosing cholangitis (PSC) is accompanied by an increased risk of cholangiocarcinoma. The problem is high recurrence rate of PSC is known after LDLT compared to cadaveric LT. Further discussion is needed whether indication of LDLT should be widened for patients with cholangiocarcinoma in Japan. We herein review recent reports from western countries, and summarize our data of LDLT for cholangiocarcinoma.

Journal

  • Tando

    Tando 28(5), 756-762, 2014

    Japan Biliary Association

Codes

  • NII Article ID (NAID)
    130004838925
  • Text Lang
    JPN
  • ISSN
    0914-0077
  • Data Source
    J-STAGE 
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