Division of Transplantation, Department of Surgery, Virginia Commonwealth, University Health System, Richmond, VA, USA.
Ann Hepatol. 2009 Oct-Dec;8(4):298-307.
It has been 4 years since the first, long-term (> 3 years) prospective comparison of adult-to-adult living donor liver transplantation (A2ALLTx) to adult deceased donor liver transplantation (ADDLTx) was reported. In this follow up, prospective, IRB approved, 10-year comparison of A2ALLTx to ADDLTx we expand on our initial observations. This data includes: 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 10 years, 465 ADDLTx (81.3%) and 107 A2ALLTx (18.7%) were performed at VCUHS. Hepatitis C virus (HCV) was the most common reason for transplantation in both groups (54.5% vs. 48.2%). Data regarding overall patient and graft survival 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 (9.6% vs. 21.7%) and more biliary complications (27.1% vs. 17.6%). In conclusion, 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.
自首例成人对成人活体肝移植（A2ALLTx）与成人尸体供肝肝移植（ADDLTx）的长期（>3 年）前瞻性比较报告以来，已经过去了 4 年。在本次随访中，我们对 A2ALLTx 与 ADDLTx 的 10 年前瞻性、IRB 批准的比较扩展了我们最初的观察结果。这些数据包括：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、急性和慢性排斥反应、移植物和患者存活率、费用和移植后并发症。在 10 年内，VCUHS 共进行了 465 例 ADDLTx（81.3%）和 107 例 A2ALLTx（18.7%）。两组中丙型肝炎病毒（HCV）都是最常见的移植原因（54.5%比 48.2%）。关于总体患者和移植物存活率以及再次移植率的数据相似。在 HCV 患者和非 HCV 患者中，患者/移植物存活率和再次移植率的比较无统计学差异。A2ALLTx 患者的急性排斥反应发生率较低（9.6%比 21.7%），胆管并发症发生率较高（27.1%比 17.6%）。总之，A2ALLTx 是一种与 ADDLTx 一样持久的肝替代技术。A2ALLTx 患者年龄较小，MELD 评分较低，急性排斥反应较少，HCV 组织学复发情况相似。A2ALLTx 患者的胆管并发症更为常见，但与 ADDLTx 相比，并未导致移植物丢失增加。
