界定北美活体供肝移植的长期预后。
Defining long-term outcomes with living donor liver transplantation in North America.
作者信息
Olthoff Kim M, Smith Abigail R, Abecassis Michael, Baker Talia, Emond Jean C, Berg Carl L, Beil Charlotte A, Burton James R, Fisher Robert A, Freise Chris E, Gillespie Brenda W, Grant David R, Humar Abhinav, Kam Igal, Merion Robert M, Pomfret Elizabeth A, Samstein Benjamin, Shaked Abraham
机构信息
*Department of Surgery, University of Pennsylvania, Philadelphia, PA †Department of Biostatistics, University of Michigan, Ann Arbor, MI ‡Arbor Research Collaborative for Health, Ann Arbor, MI §Northwestern University Comprehensive Transplant Center, Chicago, IL ¶Center for Liver Disease and Transplantation, Columbia University, New York, NY ∥Duke University Health System, Durham, NC **Department of Medicine, University of Colorado, Aurora, CO ††Division of Transplantation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA ‡‡Department of Surgery, University of California San Francisco, San Francisco, CA §§Department of General Surgery, Toronto Hospital, General Division, Toronto, Ontario, Canada ¶¶Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA ∥∥Department of Surgery, University of Colorado, Denver, CO ***Department of Surgery, University of Michigan, Ann Arbor, MI; and †††Department of Transplantation, Lahey Clinic Medical Center, Tufts University School of Medicine, Boston, MA.
出版信息
Ann Surg. 2015 Sep;262(3):465-75; discussion 473-5. doi: 10.1097/SLA.0000000000001383.
OBJECTIVES
To compare long-term survival of living donor liver transplant (LDLT) at experienced transplant centers with outcomes of deceased donor liver transplant and identify key variables impacting patient and graft survival.
BACKGROUND
The Adult-to-Adult Living Donor Liver Transplantation Cohort Study is a prospective multicenter National Institutes of Health study comparing outcomes of LDLT and deceased donor liver transplant and associated risks.
METHODS
Mortality and graft failure for 1427 liver recipients (963 LDLT) enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study who received transplant between January 1, 1998, and January 31, 2014, at 12 North American centers with median follow-up 6.7 years were analyzed using Kaplan-Meier and multivariable Cox models.
RESULTS
Survival probability at 10 years was 70% for LDLT and 64% for deceased donor liver transplant. Unadjusted survival was higher with LDLT (hazard ratio = 0.76, P = 0.02) but attenuated after adjustment (hazard ratio = 0.98, P = 0.90) as LDLT recipients had lower mean model for end-stage liver disease (15.5 vs 20.4) and fewer received transplant from intensive care unit, were inpatient, on dialysis, were ventilated, or with ascites. Posttransplant intensive care unit days were less for LDLT recipients. For all recipients, female sex and primary sclerosing cholangitis were associated with improved survival, whereas dialysis and older recipient/donor age were associated with worse survival. Higher model for end-stage liver disease score was associated with increased graft failure. Era of transplantation and type of donated lobe did not impact survival in LDLT.
CONCLUSIONS
LDLT provides significant long-term transplant benefit, resulting in transplantation at a lower model for end-stage liver disease score, decreased death on waitlist, and excellent posttransplant outcomes. Recipient diagnosis, disease severity, renal failure, and ages of recipient and donor should be considered in decision making regarding timing of transplant and donor options.Clinical Trials ID: NCT00096733.
目的
比较经验丰富的移植中心活体供肝移植（LDLT）与尸体供肝移植的长期生存率，并确定影响患者和移植物存活的关键变量。
背景
成人对成人活体供肝移植队列研究是一项由美国国立卫生研究院开展的前瞻性多中心研究，旨在比较LDLT和尸体供肝移植的结果及相关风险。
方法
对1998年1月1日至2014年1月31日期间在北美12个中心接受移植的1427例肝移植受者（963例LDLT）进行分析，这些患者纳入了成人对成人活体供肝移植队列研究，中位随访时间为6.7年，采用Kaplan-Meier法和多变量Cox模型进行分析。
结果
LDLT组10年生存率为70%，尸体供肝移植组为64%。未调整时LDLT的生存率更高（风险比=0.76，P=0.02），但调整后有所减弱（风险比=0.98，P=0.90），因为LDLT受者的终末期肝病平均模型较低（15.5对20.4），且接受重症监护病房移植、住院、透析、机械通气或有腹水的患者较少。LDLT受者移植后在重症监护病房的天数较少。对于所有受者，女性和原发性硬化性胆管炎与生存率提高相关，而透析以及受者/供者年龄较大与生存率较差相关。终末期肝病评分较高与移植物失败增加相关。移植时代和供肝叶类型不影响LDLT的生存率。
结论
LDLT提供了显著的长期移植益处，可在较低的终末期肝病评分下进行移植，减少等待名单上的死亡，并获得优异的移植后结果。在决定移植时机和供者选择时，应考虑受者诊断、疾病严重程度、肾衰竭以及受者和供者的年龄。临床试验标识：NCT00096733
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