左外叶成人对成人活体肝移植是否已准备好广泛应用？美国的经验（1998-2010 年）。
Is left lobe adult-to-adult living donor liver transplantation ready for widespread use? The US experience (1998-2010).
机构信息
Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
出版信息
HPB (Oxford). 2012 Jul;14(7):455-60. doi: 10.1111/j.1477-2574.2012.00475.x. Epub 2012 May 11.
OBJECTIVES
Living donor liver transplantation (LDLT) is an accepted treatment for patients with end-stage liver disease. To minimize risk to the donor, left lobe (LL) LDLT may be an ideal option in adult LDLT.
METHODS
This study assessed the outcomes of LL-LDLT compared with right lobe (RL) LDLT in adults (1998-2010) as reported to the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN).
RESULTS
A total of 2844 recipients of LDLT were identified. Of these, 2690 (94.6%) underwent RL-LDLT and 154 (5.4%) underwent LL-LDLT. A recent increase in the number of LL-LDLTs was noted: average numbers of LL-LDLTs per year were 5.2 during 1998-2003 and 19.4 during 2004-2010. Compared with RL-LDLT recipients, LL-LDLT recipients were younger (mean age: 50.5 years vs. 47.0 years), had a lower body mass index (BMI) (mean BMI: 24.5 kg/m(2) vs. 26.8 kg/m(2)), and were more likely to be female (64.6% vs. 41.9%). Donors in LL-LDLT had a higher BMI (mean BMI: 29.4 kg/m(2) vs. 26.5 kg/m(2)) and were less likely to be female (30.9% vs. 48.1%). Recipients of LL-LDLT had a longer mean length of stay (24.9 days vs. 18.2 days) and higher retransplantation rates (20.3% vs. 10.9%). Allograft survival in LL-LDLT was significantly lower than in RL-LDLT and there was a trend towards inferior patient survival. In Cox regression analysis, LL-LDLT was found to be associated with an increased risk for allograft failure [hazard ratio (HR): 2.39)] and inferior patient survival (HR: 1.86).
CONCLUSIONS
The number of LL-LDLTs has increased in recent years.
目的
活体肝移植（LDLT）是治疗终末期肝病患者的一种公认的治疗方法。为了使供体的风险最小化，左叶（LL）LDLT 可能是成人 LDLT 的理想选择。
方法
本研究评估了 1998 年至 2010 年向美国器官共享联合网络（UNOS）器官获取与移植网络（OPTN）报告的成人 LL-LDLT 与右叶（RL）LDLT 的结果。
结果
共确定了 2844 例 LDLT 受者。其中，2690 例（94.6%）接受 RL-LDLT，154 例（5.4%）接受 LL-LDLT。注意到 LL-LDLT 的数量最近有所增加：1998 年至 2003 年每年平均 LL-LDLT 数量为 5.2 例，2004 年至 2010 年每年平均 LL-LDLT 数量为 19.4 例。与 RL-LDLT 受者相比，LL-LDLT 受者年龄更小（平均年龄：50.5 岁 vs. 47.0 岁），体重指数（BMI）较低（平均 BMI：24.5kg/m² vs. 26.8kg/m²），女性比例更高（64.6% vs. 41.9%）。LL-LDLT 供者的 BMI 较高（平均 BMI：29.4kg/m² vs. 26.5kg/m²），女性比例较低（30.9% vs. 48.1%）。LL-LDLT 受者的平均住院时间较长（24.9 天 vs. 18.2 天），再次移植率较高（20.3% vs. 10.9%）。LL-LDLT 的移植物存活率明显低于 RL-LDLT，患者存活率也呈下降趋势。在 Cox 回归分析中，LL-LDLT 与移植物衰竭风险增加相关[风险比（HR）：2.39]，且患者存活率较低（HR：1.86）。
结论
近年来，LL-LDLT 的数量有所增加。
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