Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA.
Liver Transpl. 2019 Apr;25(4):580-587. doi: 10.1002/lt.25073. Epub 2019 Mar 6.
In this era of organ scarcity, living donor liver transplantation (LDLT) is an alternative to using deceased donors, and in Western countries, it is more often used for recipients with low Model for End-Stage Liver Disease (MELD) scores. We sought to compare the patient survival and graft survival between recipients of liver transplantation from living donors and donation after circulatory death (DCD) donors in patients with low MELD scores. This is a retrospective cohort analysis of adult liver transplant recipients with a laboratory MELD of ≤20 who underwent transplantation between January 1, 2003 and March 31, 2016. Recipients were categorized by donor graft type (DCD or LDLT), and recipient and donor characteristics were compared. Ten-year patient and graft survival curves were calculated using Kaplan-Meier analyses, and a mixed-effects model was performed to determine the contributions of recipient, donor, and center variables on patient and graft survival. There were 36,705 liver transplants performed: 32,255 (87.9%) from DBD donors, 2166 (5.9%) from DCD donors, and 2284 (6.2%) from living donors. In the mixed-effects model, DCD status was associated with a higher risk of graft failure (relative risk [RR], 1.27; 95% confidence interval [CI], 1.16-1.38) but not worse patient survival (RR, 1.27; 95% CI, 0.96-1.67). Lower DCD center experience was associated with a 1.21 higher risk of patient death (95% CI, 1.17-1.25) and a 1.13 higher risk of graft failure (95% CI, 1.12-1.15). LDLT center experience was also predictive of patient survival (RR, 1.03; 95% CI, 1.02-1.03) and graft failure (RR, 1.05; 95% CI, 1.05-1.06). In conclusion, for liver transplant recipients with low laboratory MELD, LDLT offers better graft survival and a tendency to better patient survival than DCD donors.
在器官短缺的时代，活体供肝移植（LDLT）是使用已故供体的替代方案，在西方国家，它更常用于 MELD 评分较低的受者。我们旨在比较 MELD 评分较低的患者接受活体供体和心脏死亡后供体（DCD）供肝移植的患者的生存率和移植物存活率。这是一项对 2003 年 1 月 1 日至 2016 年 3 月 31 日期间接受移植的实验室 MELD≤20 的成人肝移植受者的回顾性队列分析。受者根据供体移植物类型（DCD 或 LDLT）进行分类，并比较受者和供者特征。使用 Kaplan-Meier 分析计算 10 年患者和移植物存活率曲线，并进行混合效应模型以确定受者、供者和中心变量对患者和移植物存活率的贡献。共进行了 36705 例肝移植：32255 例（87.9%）来自 DBD 供者，2166 例（5.9%）来自 DCD 供者，2284 例（6.2%）来自活体供者。在混合效应模型中，DCD 状态与移植物失败的风险较高相关（相对风险 [RR]，1.27；95%置信区间 [CI]，1.16-1.38），但与患者生存率较差无关（RR，1.27；95% CI，0.96-1.67）。较低的 DCD 中心经验与患者死亡的风险增加 1.21 相关（95% CI，1.17-1.25）和移植物失败的风险增加 1.13 相关（95% CI，1.12-1.15）。LDLT 中心经验也可预测患者生存率（RR，1.03；95% CI，1.02-1.03）和移植物失败（RR，1.05；95% CI，1.05-1.06）。总之，对于 MELD 评分较低的肝移植受者，LDLT 提供了更好的移植物存活率，并且具有更好的患者生存率趋势，优于 DCD 供体。
