Barbas Andrew S, Goldaracena Nicolas, Dib Martin J, Al-Adra David P, Aravinthan Aloysious D, Lilly Leslie B, Renner Eberhard L, Selzner Nazia, Bhat Mamatha, Cattral Mark S, Ghanekar Anand, McGilvray Ian D, Sapisochin Gonzalo, Selzner Markus, Greig Paul D, Grant David R
Multi-Organ Transplant Program, University of Toronto, Toronto, ON, Canada.
Transplant Direct. 2017 May 10;3(6):e158. doi: 10.1097/TXD.0000000000000674. eCollection 2017 Jun.
In parallel with the obesity epidemic, liver transplantation for nonalcoholic steatohepatitis (NASH) is increasing dramatically in North America. Although survival outcomes are similar to other etiologies, liver transplantation in the NASH population has been associated with significantly increased resource utilization. We sought to compare outcomes between live donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) at a high volume North American transplant center, with a particular focus on resource utilization.
The study population consists of primary liver transplants performed for NASH at Toronto General Hospital from 2000 to 2014. Recipient characteristics, perioperative outcomes, graft and patient survivals, and resource utilization were compared for LDLT versus DDLT.
A total of 176 patients were included in the study (48 LDLT vs 128 DDLT). LDLT recipients had a lower model for end-stage liver disease score and were less frequently hospitalized prior to transplant. Estimated blood loss and early markers of graft injury were lower for LDLT. LDLT recipients had a significantly shorter hospitalization (intensive care unit, postoperative, and total hospitalization).
LDLT for NASH facilitates transplantation of patients at a less severe stage of disease, which appears to promote a faster postoperative recovery with less resource utilization.
随着肥胖症的流行，北美地区非酒精性脂肪性肝炎（NASH）患者的肝移植数量急剧增加。尽管NASH患者肝移植后的生存结果与其他病因的患者相似，但该群体的肝移植资源利用率显著增加。我们试图在北美一家大型移植中心比较活体供肝肝移植（LDLT）和尸体供肝肝移植（DDLT）的结果，特别关注资源利用情况。
研究人群包括2000年至2014年在多伦多综合医院因NASH接受的初次肝移植患者。比较LDLT和DDLT患者的受者特征、围手术期结果、移植物和患者生存率以及资源利用情况。
共有176例患者纳入研究（48例LDLT和128例DDLT）。LDLT受者的终末期肝病模型评分较低，移植前住院频率较低。LDLT的估计失血量和移植物损伤早期标志物较低。LDLT受者的住院时间（重症监护病房、术后和总住院时间）显著缩短。
NASH患者接受LDLT可使病情较轻阶段的患者接受移植，这似乎能促进术后更快恢复，同时减少资源利用。
