Nguyen Thanh H K, Melancon Keith, Lake John, Payne William, Humar Abhinav
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Clin Transplant. 2008 Sep-Oct;22(5):624-9. doi: 10.1111/j.1399-0012.2008.00834.x. Epub 2008 May 4.
We looked at acute rejection (AR) rates in adult liver transplant recipients to determine if graft type (whole liver vs. partial liver) or donor source (living vs. deceased donor) influenced the risk for AR. Between 1999 and 2005, we performed 292 whole liver transplants from a deceased donor (DD-WL) and 91 partial transplants, either from a living donor (LDLT, n = 59) or split liver from a deceased donor (DD-SL, n = 32). Pediatric recipients were not included. The groups were well matched by age and type of liver disease (p = ns), but mean model for end-stage liver disease (MELD) scores were higher in the DD-WL vs. LD recipient groups (p < 0.01). Immunosuppression was similar for all. AR rates at 12 months post-transplant were lower in the LDLT group (10.0%) vs. the DD-WL group (16.5%, p = 0.10), although this was not statistically significant. AR rates in the DD-SL transplant group (12.8%) were intermediate compared with the two other groups and not statistically different from either group (p = ns). By multivariate analysis, however, neither graft type (partial vs. whole) nor donor source (LD vs. DD) seemed to have an impact on the risk for AR. The only factor that was associated with an increased risk for AR was not using induction therapy.
我们观察了成人肝移植受者的急性排斥反应(AR)发生率,以确定移植物类型(全肝与部分肝)或供体来源(活体与脑死亡供体)是否会影响AR风险。1999年至2005年期间,我们实施了292例脑死亡供体全肝移植(DD-WL)和91例部分肝移植,后者要么来自活体供体(LDLT,n = 59),要么是脑死亡供体的劈裂肝(DD-SL,n = 32)。未纳入儿科受者。这些组在年龄和肝病类型方面匹配良好(p =无统计学意义),但DD-WL受者组的终末期肝病平均模型(MELD)评分高于LDLT受者组(p < 0.01)。所有组的免疫抑制方案相似。移植后12个月时,LDLT组的AR发生率(10.0%)低于DD-WL组(16.5%,p = 0.10),尽管这一差异无统计学意义。DD-SL移植组的AR发生率(12.8%)介于其他两组之间,与两组相比均无统计学差异(p =无统计学意义)。然而,通过多变量分析,移植物类型(部分肝与全肝)和供体来源(LDLT与DD)似乎均未对AR风险产生影响。与AR风险增加相关的唯一因素是未使用诱导治疗。