Patel S, Orloff M, Tsoulfas G, Kashyap R, Jain A, Bozorgzadeh A, Abt P
Division of Transplantation, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Am J Transplant. 2007 Oct;7(10):2344-9. doi: 10.1111/j.1600-6143.2007.01938.x.
Donor safety has been scrutinized by both the medical community and the media. Variability exists in reported donor complications and associated risk factors are ill defined. Use of administrative data can overcome the bias of single-center studies and explore variables associated with untoward events. A retrospective cohort study identifying living liver donors in two large healthcare registries yielded 433 right and left lobe donors from 13 centers between 2001 and 2005. Perioperative complications were identified using International Classification of Diseases, 9th Revision (ICD-9) coding data and classified according to the Clavien system. Logistic regression models identified factors associated with complications. There was one perioperative death (0.23%). The overall complication rate was 29.1% and major complication rate defined by a Clavien grade >or=3 was 3.5%. Center living-donor volume (OR = 0.97, 95% CI = 0.95-0.99) and the ratio of living-donors to all donors (living and deceased) (OR = 0.94, 95% CI = 0.92-0.96) were associated with a lower risk of all complications. Donor age >50 years (OR = 4.25, 95% CI = 1.22-14.87) was associated with a higher risk of major complications. Living liver donation is currently performed with a low risk of major morbidity. Use of administrative data represents an important tool to facilitate a better understanding of donor risk factors.
供体安全问题受到了医学界和媒体的审视。报告的供体并发症存在差异，相关风险因素也不明确。使用行政数据可以克服单中心研究的偏差，并探索与不良事件相关的变量。一项回顾性队列研究在两个大型医疗登记处识别活体肝供体，2001年至2005年间从13个中心获得了433例右叶和左叶供体。使用国际疾病分类第九版（ICD-9）编码数据识别围手术期并发症，并根据Clavien系统进行分类。逻辑回归模型确定了与并发症相关的因素。有1例围手术期死亡（0.23%）。总体并发症发生率为29.1%，Clavien分级≥3级定义的主要并发症发生率为3.5%。中心活体供体数量（OR = 0.97，95%CI = 0.95 - 0.99）以及活体供体与所有供体（活体和已故）的比例（OR = 0.94，95%CI = 0.92 - 0.96）与所有并发症的较低风险相关。供体年龄>50岁（OR = 4.25，95%CI = 1.22 - 14.87）与主要并发症的较高风险相关。目前进行活体肝捐赠时严重发病风险较低。使用行政数据是促进更好地理解供体风险因素的重要工具。
