Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Ann Surg. 2010 Mar;251(3):542-9. doi: 10.1097/SLA.0b013e3181ccb370.
To compare rates of hospitalization before and after adult-to-adult living donor liver transplant (LDLT) and deceased donor liver transplant (DDLT).
LDLT recipients have been reported to have lower mortality but a higher complication rate than DDLT recipients. The higher complication rate may be associated with greater consumption of inpatient hospital resources and a higher burden of disease for LDLT recipients.
Data from the 9-center Adult-to-Adult Living Donor Liver Transplantation retrospective cohort study were analyzed to determine pretransplant, transplant, and posttransplant hospitalizations among LDLT candidates (potential living donor was evaluated) who received LDLT or DDLT. Hospital days and admission rates for LDLT and DDLT patients were calculated per patient-year at risk, starting from the date of initial potential donor history and physical examination. Rates were compared using overdispersed Poisson regression models.
Among 806 candidates, 384 received LDLT and 215 received DDLT. In addition to the 599 transplants, there were 1913 recipient hospitalizations (485 pretransplant; 1428 posttransplant). Mean DDLT recipient pretransplant, transplant, and posttransplant lengths of stay were 5.8 +/- 6.3, 27.0 +/- 32.6, and 9.0 +/- 14.1 days, respectively, and for LDLT were 4.1 +/- 3.7, 21.4 +/- 24.3, and 7.8 +/- 11.4 days, respectively. Compared with DDLT, LDLT recipients had significantly lower adjusted pretransplant hospital day and admission rates, but significantly higher posttransplant rates. Significantly higher LDLT admission rates were observed for biliary tract morbidity throughout the second posttransplant year. Overall hospitalization rates starting from the point of potential donor evaluation were significantly higher for eventual recipients of LDLT.
LDLT recipients, despite lower acuity of disease, have higher hospitalization requirements when compared with DDLT recipients. Continuing efforts are warranted to reduce the incidence of complications requiring post-LDLT inpatient admission, with particular emphasis on biliary tract issues.
比较成人对成人活体供肝移植（LDLT）和尸体供肝移植（DDLT）前后的住院率。
已有报道称，LDLT 受者的死亡率较低，但并发症发生率高于 DDLT 受者。较高的并发症发生率可能与 LDLT 受者对住院医疗资源的消耗更大，以及疾病负担更高有关。
对 9 个中心成人对成人活体供肝移植回顾性队列研究的数据进行分析，以确定接受 LDLT 或 DDLT 的 LDLT 候选者（评估潜在活体供者）的移植前、移植中和移植后的住院情况。根据每位患者的潜在供者病史和体检日期，计算每位患者每年的住院天数和入院率。采用过度离散泊松回归模型比较住院率。
在 806 名候选者中，384 名接受 LDLT，215 名接受 DDLT。除了 599 例移植外，还有 1913 例受者住院（485 例移植前；1428 例移植后）。DDLT 受者移植前、移植中和移植后的平均住院时间分别为 5.8 ± 6.3、27.0 ± 32.6 和 9.0 ± 14.1 天，LDLT 受者分别为 4.1 ± 3.7、21.4 ± 24.3 和 7.8 ± 11.4 天。与 DDLT 相比，LDLT 受者的移植前住院天数和入院率明显较低，但移植后的住院率明显较高。在移植后第二年，胆道并发症的 LDLT 入院率明显较高。从潜在供者评估开始，最终接受 LDLT 的患者的整体住院率明显较高。
尽管 LDLT 受者的疾病严重程度较低，但与 DDLT 受者相比，他们的住院需求更高。需要继续努力降低需要 LDLT 住院治疗的并发症发生率，特别是胆道问题。
