Maluf Daniel G, Stravitz Richard Todd, Cotterell Adrian H, Posner Marc P, Nakatsuka Mitsuru, Sterling Richard K, Luketic Velimir A, Shiffman Mitchell L, Ham John M, Marcos Amadeo, Behnke Martha K, Fisher Robert A
Division of Transplantation, Department of Surgery, Virginia Commonwealth University Health System, Richmon, VA, USA.
Am J Transplant. 2005 Jan;5(1):149-56. doi: 10.1111/j.1600-6143.2004.00654.x.
No long-term (>3 years) prospective comparison of adult-to-adult living donor liver transplantation (A2ALLTx) to adult deceased donor liver transplantation (ADDLTx) has been reported. This is a prospective, IRB approved, 6-year comparison of A2ALLTx to ADDLTx. Data include: age, gender, ethnicity, primary liver disease, waiting time, pretransplant CTP/MELD score, cold ischemia time (CIT), perioperative mortality, acute and chronic rejection, graft and patient survival, charges and post-transplant complications. In 6 years, 202 ADDLTx (74.5%) and 69 A2ALLTx (25.5%) were performed at VCUHS. Hepatitis C virus (HCV) was the most common reason for transplantation in both groups (48.1% vs. 42%). Data regarding overall patient and graft survival, monetary charges and retransplantation rates were similar. Comparison of patient/graft survivals, retransplantation rates in patients with and without HCV were not statistically different. A2ALLTx patients had less acute rejection (11.5% vs. 23.9%) and more biliary complications (26.1% vs. 11.4%). Overall, A2ALLTx is as durable a liver replacement technique as the ADDLTx. Patients with A2ALLTx were younger, had lower MELD scores, less acute rejection and similar histological HCV recurrence. Biliary complications were more common in A2ALLTx but were not associated with increased graft loss compared to ADDLTx.
目前尚无关于成人活体肝移植（A2ALLTx）与成人尸体肝移植（ADDLTx）的长期（>3年）前瞻性比较报道。这是一项经机构审查委员会（IRB）批准的A2ALLTx与ADDLTx的6年前瞻性比较研究。数据包括：年龄、性别、种族、原发性肝病、等待时间、移植前CTP/MELD评分、冷缺血时间（CIT）、围手术期死亡率、急慢性排斥反应、移植物和患者生存率、费用以及移植后并发症。在6年时间里，弗吉尼亚联邦大学医疗中心（VCUHS）共进行了202例ADDLTx（74.5%）和69例A2ALLTx（25.5%）。丙型肝炎病毒（HCV）是两组中最常见的移植原因（48.1%对42%）。关于总体患者和移植物生存率、费用及再次移植率的数据相似。有或无HCV患者的患者/移植物生存率及再次移植率比较无统计学差异。A2ALLTx患者的急性排斥反应较少（11.5%对23.9%），但胆道并发症较多（26.1%对11.4%）。总体而言，A2ALLTx作为一种肝脏替代技术与ADDLTx一样持久。接受A2ALLTx的患者更年轻，MELD评分更低，急性排斥反应更少，且组织学上HCV复发情况相似。A2ALLTx中胆道并发症更常见，但与ADDLTx相比，并未增加移植物丢失。
