Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Biomed Res Int. 2020 Aug 24;2020:1320830. doi: 10.1155/2020/1320830. eCollection 2020.
Living donor liver transplantation (LDLT) provides an alternative to deceased donor liver transplantation (DDLT) for patients with end-stage liver disease in the circumstance of scarcity of deceased grafts. However, the outcomes of LDLT remain controversial.
A systematic review and meta-analysis were performed to compare the outcomes of LDLT with DDLT. Twelve outcomes were assessed.
Thirty-nine studies involving 38563 patients were included. LDLT was comparable in red blood cell transfusion, perioperative mortality, length of hospital stay, retransplantation rate, hepatitis C virus recurrence rate, and hepatocellular carcinoma recurrence rate with DDLT. Cold ischemia time was shorter and duration of recipient operation was longer in LDLT. Postoperative intra-abdominal bleeding rate occurred less frequently in LDLT recipients (odds ratio (OR) = 0.64, 95%confidence interval (CI) = 0.46 - 0.88, = 0.006), but this did not decrease the perioperative mortality. LDLT was associated with significantly higher biliary (OR = 2.23, 95%CI = 1.59 - 3.13, < 0.00001) and vascular (OR = 2.00, 95%CI = 1.31 - 3.07, = 0.001) complication rates and better overall survival (OS) (1 year: OR = 1.32, 95%CI = 1.01 - 1.72, = 0.04; 3 years: OR = 1.39, 95%CI = 1.14 - 1.69, = 0.0010; and 5 years: OR = 1.33, 95%CI = 1.04 - 1.70, = 0.02). According to subgroup analysis, biliary complication rate and OS improved dramatically as experience increased, while vascular complication rate could not be improved because it was mainly caused by the difference of the donor type itself.
LDLT remains a valuable option for patients in need of liver transplantation for it provides an excellent alternative to DDLT without compromising recipient outcomes. Further refinement in biliary and vascular reconstruction techniques and the accumulation of liver transplantation centers' experience are the key factors in expanding the application of LDLT.
在供体器官短缺的情况下，活体肝移植（LDLT）为终末期肝病患者提供了一种替代死体供肝移植（DDLT）的方法。然而，LDLT 的结果仍存在争议。
本研究进行了系统评价和荟萃分析，以比较 LDLT 与 DDLT 的结果。评估了 12 项结果。
共纳入 39 项研究，涉及 38563 名患者。LDLT 在红细胞输注、围手术期死亡率、住院时间、再次移植率、丙型肝炎病毒复发率和肝细胞癌复发率方面与 DDLT 相当。LDLT 的冷缺血时间更短，受体手术时间更长。LDLT 术后腹腔内出血发生率较低（比值比（OR）=0.64，95%置信区间（CI）=0.46-0.88， =0.006），但并未降低围手术期死亡率。LDLT 与较高的胆道（OR=2.23，95%CI=1.59-3.13， ＜0.00001）和血管（OR=2.00，95%CI=1.31-3.07， =0.001）并发症发生率和更好的总体生存率（OS）（1 年：OR=1.32，95%CI=1.01-1.72， =0.04；3 年：OR=1.39，95%CI=1.14-1.69， =0.0010；5 年：OR=1.33，95%CI=1.04-1.70， =0.02）相关。根据亚组分析，胆道并发症发生率和 OS 随着经验的增加而显著改善，而血管并发症发生率无法改善，因为这主要是由供体类型本身的差异造成的。
LDLT 仍然是需要肝移植的患者的有价值的选择，因为它为 DDLT 提供了一个极好的替代方案，而不会影响受体的结果。进一步完善胆道和血管重建技术，并积累肝移植中心的经验，是扩大 LDLT 应用的关键因素。
