Gruessner R W G, Gruessner A C
Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY.
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
Transplant Proc. 2018 Dec;50(10):3025-3035. doi: 10.1016/j.transproceed.2018.07.024.
Transplantation of organs from living donors helps to decrease the organ shortage and shortens waiting times. Living donor (LD) transplantation is also generally associated with better outcomes. Unfortunately, there has been no comprehensive analysis and comparison of all types of solid-organ transplantation from living donors since the inception of the United Network for Organ Sharing (UNOS).
Using the UNOS/Organ Procurement and Transplantation Network (OPTN) database, all LD transplants from October 1, 1987, to December 31, 2015, were studied with univariate and multivariate analyses.
A total of 140,090 organs were transplanted from LDs, accounting for 21% of all transplants in the United States. Over 95% were kidney; 4% were liver; and <1% intestine, lung, and pancreas LDs. Only LD kidney transplant patient and graft survival rates were significantly higher compared deceased donor transplants over the period of analysis. The best long-term LD transplant results were achieved in pediatric liver recipients. Significantly more women than men donated organs and significantly more men than women received solid-organ transplants. A regional disparity was observed for LD kidney as well as for LD liver transplants. Despite improvements in outcomes and increased use of nonbiologic donors, the number of LD transplants in the United States has declined. This decline was greater in children than adults and was noted for all types of organ transplants.
Further efforts are needed to educate the public, health professionals, and transplant candidates on the advantages of living vs deceased donor organ transplantation. Compared with other countries, LD transplantation has yet to reach its full potential in the United States.
活体供体器官移植有助于缓解器官短缺问题并缩短等待时间。活体供体（LD）移植通常也会带来更好的治疗效果。不幸的是，自器官共享联合网络（UNOS）成立以来，尚未对所有类型的活体供体实体器官移植进行全面分析和比较。
利用UNOS/器官获取与移植网络（OPTN）数据库，对1987年10月1日至2015年12月31日期间的所有LD移植进行单因素和多因素分析。
共进行了140,090例LD器官移植，占美国所有移植手术的21%。超过95%为肾脏移植；4%为肝脏移植；肠道、肺和胰腺LD移植占比不到1%。在分析期内，只有LD肾移植患者和移植物存活率显著高于尸体供体移植。小儿肝移植受者取得了最佳的长期LD移植效果。捐赠器官的女性明显多于男性，接受实体器官移植的男性明显多于女性。LD肾移植和LD肝移植均存在地区差异。尽管治疗效果有所改善且非生物供体的使用增加，但美国LD移植的数量仍在下降。儿童的下降幅度大于成人，且所有类型的器官移植均出现这种情况。
需要进一步努力，向公众、卫生专业人员和移植候选人宣传活体供体与尸体供体器官移植的优势。与其他国家相比，LD移植在美国尚未充分发挥其潜力。
