Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH Division of Gastroenterology, Hepatology and Nutrition The Ohio State University Wexner Medical Center Columbus OH Department of Surgery The Ohio State University Wexner Medical Center Columbus OH Division of Hospital Medicine The Ohio State University Wexner Medical Center Columbus OH Center for BiostatisticsDepartment of Biomedical Informatics The Ohio State University Wexner Medical Center Columbus OH.
Liver Transpl. 2021 Nov;27(11):1603-1612. doi: 10.1002/lt.26223. Epub 2021 Aug 16.
We studied the trends and various outcomes, including the readmission rates, health care utilization, and complications among living liver donors (LLDs) in the United States. We queried the National Database for data from 2010 to 2017 for all LLDs. The primary outcomes were 30-day and 90-day readmission rates. The secondary outcomes included health care use (length of stay [LOS], cost of care), index admission, and calendar-year mortality. Logistic regression models were fit for various outcomes. A total of 1316 LLDs underwent hepatectomy during the study period. The median donor age was 35.0 years (interquartile range, 27.4-43.6), and donors were predominantly women (54.2%). The trend of LLD surgeries remained stable at large medical centers (85.3%). The 30-day and 90-day readmission rates were low at 5% and 5.9%, respectively. Older age (50 years and older; 8%; confidence interval [CI], 0.6%-15.9%; P = 0.03) and hepatectomy at small to medium-sized hospitals were associated with increased index LOS (13.4%; 95% CI, 3.1%-24.7%; P = 0.01). Moreover, older age of donor (-11.3%; 95% CI, -20.3% to -1.4%; P = 0.03), Elixhauser score ≥3 (17%; 95% CI, 1.2%-35.3%; P = 0.03), and Medicaid insurance (24.5%; 95% CI, 1.2%-53.1%; P = 0.04) were also associated with increased cost. The overall rate of any complications during index admission was 42.8%. Male sex (odds ratio [OR], 1.63; 95% CI, 1.19-2.23) was an independent predictor of post-LLD complications. There was no index admission or calendar-year mortality reported during the study period. This is the largest national report of LLDs to date, showing that the trend of LLD surgeries is stable in the United States. With established safety, fewer complications, and less health care utilization, LLDs can be a potential source of continuation of liver transplantation in the context of changing liver allocation policies in the United States.
我们研究了美国活体肝供者（LLD）的趋势和各种结果，包括再入院率、医疗保健利用情况和并发症。我们从 2010 年至 2017 年在国家数据库中查询了所有 LLD 的数据。主要结果是 30 天和 90 天的再入院率。次要结果包括医疗保健利用情况（住院时间 [LOS]、护理费用）、指数入院和日历年度死亡率。使用逻辑回归模型对各种结果进行拟合。共有 1316 名 LLD 在研究期间接受了肝切除术。供者的中位年龄为 35.0 岁（四分位距，27.4-43.6），供者主要为女性（54.2%）。大型医疗机构的 LLD 手术趋势保持稳定（85.3%）。30 天和 90 天的再入院率分别为 5%和 5.9%，较低。年龄较大（50 岁及以上；8%；置信区间 [CI]，0.6%-15.9%；P = 0.03）和在中小医院进行肝切除术与指数 LOS 延长相关（13.4%；95%CI，3.1%-24.7%；P = 0.01）。此外，供者年龄较大（-11.3%；95%CI，-20.3%至-1.4%；P = 0.03）、Elixhauser 评分≥3（17%；95%CI，1.2%-35.3%；P = 0.03）和医疗补助保险（24.5%；95%CI，1.2%-53.1%；P = 0.04）也与费用增加相关。指数入院期间任何并发症的总发生率为 42.8%。男性（比值比 [OR]，1.63；95%CI，1.19-2.23）是 LLD 后并发症的独立预测因素。在研究期间没有报告指数入院或日历年度死亡率。这是迄今为止最大的 LLD 国家报告，表明 LLD 手术在美国的趋势保持稳定。由于安全性得到确立、并发症减少且医疗保健利用率降低，LLD 可以成为美国改变肝脏分配政策背景下继续进行肝移植的潜在来源。
