Durand François, Belghiti Jacques, Troisi Roberto, Boillot Olivier, Gadano Adrian, Francoz Claire, de Hemptinne Bernard, Mallet Alain, Valla Dominique, Golmard Jean Louis
Hepatology-INSERM U481, Hospital Beaujon, Clichy, France.
Liver Transpl. 2006 Feb;12(2):231-9. doi: 10.1002/lt.20700.
Living donors represent a recognized alternative for facilitating the access to transplantation in a period of organ shortage. However, which candidates should be preferentially considered for living-donor liver transplantation (LDLT) is debated. The aim of this study was to create statistical models to determine which strategies of selection for LDLT provide the most efficient contribution. The study included 331 patients listed for deceased-donor transplantation (DDLT) and 128 transplanted with living donors. Statistical models predicting the events following listing were created and combined in a multistate model allowing the testing of different strategies of selection for LDLT and to compare their results. Taking 3-yr survival after listing as the principal end-point, selecting the 20% patients at highest risk of death on the waiting list gave better results than selecting the 20% patients at lowest risk of death after LDLT (70% vs. 64%, respectively). These strategies resulted in waiting list mortality rates of 17% and 8%, respectively. One-year survival after LDLT was lower in high-risk patients (85%) than in low-risk patients (91%). However, the 1-yr survival benefit derived from LDLT was 75% in high-risk patients while it was nil in low-risk patients. In conclusion, LDLT is more effective for overcoming the consequences of organ shortage when performed in patients at high risk of death on the waiting list. On an individual basis, the sickest patients are those who derive the most important benefit from LDLT. This study provides incentives for considering LDLT in high-risk patients.
在器官短缺时期，活体供体是促进器官移植可及性的一种公认的替代方式。然而，对于活体肝移植（LDLT）应优先考虑哪些候选者仍存在争议。本研究的目的是创建统计模型，以确定LDLT的哪些选择策略能提供最有效的贡献。该研究纳入了331例等待尸体供体移植（DDLT）的患者和128例接受活体供体移植的患者。创建了预测列入名单后事件的统计模型，并将其组合成一个多状态模型，以测试LDLT的不同选择策略并比较其结果。以列入名单后的3年生存率作为主要终点，选择等待名单上死亡风险最高的20%患者比选择LDLT后死亡风险最低的20%患者效果更好（分别为70%和64%）。这些策略导致等待名单上的死亡率分别为17%和8%。LDLT后1年生存率在高危患者中较低（85%），而在低危患者中较高（91%）。然而，LDLT给高危患者带来的1年生存获益为75%，而给低危患者带来的生存获益为零。总之，当对等待名单上死亡风险高的患者进行LDLT时，在克服器官短缺后果方面更有效。就个体而言，病情最严重的患者是从LDLT中获益最大的患者。本研究为考虑对高危患者进行LDLT提供了依据。
