Division of Transplantation, Department of Surgery, University of Washington, Seattle, Washington.
Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, Washington.
Clin Transplant. 2019 Aug;33(8):e13662. doi: 10.1111/ctr.13662. Epub 2019 Jul 26.
The impact of size mismatch in deceased donor liver transplantation is unknown. BSA has been demonstrated to be an accurate indicator of liver volume. We developed a model to match livers by BSA and estimate the impact of size mismatch on graft survival. Using the Standard Transplant Analysis and Research (STAR) database we selected solitary primary liver transplants recipients of any age, transplanted between 3/6/2002 and 12/31/2016. Using the Cox proportional hazard model, and controlling for donor and recipient factors, we determined the relative risk for graft survival for four donor/recipient body surface area ratio groups (≤0.68, 0.69-0.90, 0.91-1.25, 1.26-1.5). We studied two groups: recipients with a BSA > 1.6 (adults) and ≤1.6 (children) and a subgroup with a BSA ≤ 0.53 (small infants). In recipients with BSA > 1.6 (adults [n = 71 365]), D/R ratios ≤ 0.68 and > 1.25 had a negative impact on graft survival. In recipients with BSA ≤ 1.6 (children [n = 8339]) D/R ratios <0.75 and >1.25 had a negative impact on graft survival. In the 1725 recipients with BSA ≤ 0.53 (small infants) D/R ratios <1 and >2.3 had a negative impact on graft survival. In deceased donor liver transplantation, the D/R ratio is a significant, yet underestimated predictor of graft survival that should be considered in donor and recipient selection.
在尸体供肝肝移植中，大小不匹配的影响尚不清楚。BSA 已被证明是肝体积的准确指标。我们开发了一种通过 BSA 匹配肝脏的模型，并估计大小不匹配对移植物存活率的影响。使用标准移植分析和研究 (STAR) 数据库，我们选择了任何年龄的单独原发性肝脏移植受者，他们在 2002 年 3 月 6 日至 2016 年 12 月 31 日之间接受了移植。使用 Cox 比例风险模型，并控制供体和受者因素，我们确定了四个供体/受者体表面积比组（≤0.68、0.69-0.90、0.91-1.25、1.26-1.5）的移植物存活率相对风险。我们研究了两组：BSA>1.6（成人）和≤1.6（儿童）的受者，以及 BSA≤0.53（小婴儿）的亚组。在 BSA>1.6（成人[n=71365]）的受者中，D/R 比≤0.68 和>1.25 对移植物存活率有负面影响。在 BSA≤1.6（儿童[n=8339]）的受者中，D/R 比<0.75 和>1.25 对移植物存活率有负面影响。在 BSA≤0.53（小婴儿）的 1725 名受者中，D/R 比<1 和>2.3 对移植物存活率有负面影响。在尸体供肝肝移植中，D/R 比是移植物存活率的一个重要但被低估的预测指标，在供体和受者选择中应予以考虑。
