Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
Clin Mol Hepatol. 2021 Jul;27(3):451-462. doi: 10.3350/cmh.2020.0292. Epub 2021 Feb 2.
BACKGROUND/AIMS: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population.
This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes.
A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence.
This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.
背景/目的：分析韩国人群肝移植（LT）后结局的发生率和相关风险因素。
本研究分析了 2014 年 5 月至 2017 年 12 月期间韩国器官移植登记处（KOTRY）肝移植队列中接受活体供体肝移植（LDLT）和尸体供体肝移植（DDLT）的受者的 LT 后结局发生率。研究指标包括 LDLT 和 DDLT 受者的 LT 后结局发生率。采用 Cox 多变量比例风险模型确定预测结局的潜在风险因素。
共纳入 2563 例成人 LT 受者（LDLT，n=1956；DDLT，n=607），平均年龄（53.9±8.9）岁，72.2%为男性。LDLT 和 DDLT 受者的 LT 后结局分别为死亡（4.0%和 14.7%）、移植物失功（5.0%和 16.1%）、排斥反应（7.0%和 12.0%）、肾衰竭（2.7%和 13.8%）、新发糖尿病（12.5%和 15.4%）和肝细胞癌（HCC）复发（均为 6.7%）。在 LDLT 和 DDLT 受者中，最常见的 LT 后并发症为肾功能障碍（33.6%和 51.4%）、感染（26.7%和 48.4%）和手术并发症（22.5%和 23.9%）。DDLT 受者的这些结局发生率通常高于 LDLT 受者。多变量分析表明，受者年龄和 DDLT 是与死亡和移植物失功相关的显著风险因素。DDLT 和 ABO 不相容移植是排斥反应的预后因素，而移植前米兰标准以外的 HCC 是 HCC 复发的强预测因素。
本研究为韩国人群 LT 后预后提供了良好的指标，并提示 LT 后并发症负担较重。
