Goto Toru, Ivanics Tommy, Cattral Mark S, Reichman Trevor, Ghanekar Anand, Sapisochin Gonzalo, McGilvray Ian D, Sayed Blayne, Lilly Les, Bhat Mamatha, Selzner Markus, Selzner Nazia
Multiorgan Transplant Program, Toronto General Hospital University of Toronto Toronto ON Canada Department of SurgeryDivision of Hepato-Biliary-Pancreatic Surgery & Transplantation Kyoto University Graduate School of Medicine Kyoto Japan Department of Surgery Henry Ford Hospital Detroit MI Department of Surgical Sciences Uppsala University Akademiska Sjukhuset Uppsala Sweden.
Liver Transpl. 2022 May;28(5):834-842. doi: 10.1002/lt.26386. Epub 2022 Feb 1.
Living donor liver transplantation (LDLT) is an attractive alternative to deceased donor liver transplantation (DDLT). Although both modalities have similar short-term outcomes, long-term outcomes are not well studied. We compared the 20-year outcomes of 668 adults who received LDLT with1596 DDLTs at the largest liver transplantation (LT) program in Canada. Recipients of LDLT were significantly younger and more often male than DDLT recipients (P < 0.001). Autoimmune diseases were more frequent in LDLT, whereas viral hepatitis and alcohol-related liver disease were more frequent in DDLT. LDLT recipients had lower Model for End-Stage Liver Disease scores (P = 0.008), spent less time on the waiting list (P < 0.001), and were less often inpatients at the time of LT (P < 0.001). In a nonadjusted analysis, 1-year, 10-year, and 20-year patient survival rates were significantly higher in LDLT (93%, 74%, and 56%, respectively) versus DDLT (91%, 67%, and 46%, respectively; log-rank P = 0.02) as were graft survival rates LDLT (91%, 67%, and 50%, respectively) versus (90%, 65%, and 44.3%, respectively, for DDLT; log-rank P = 0.31). After multivariable adjustment, LDLT and DDLT were associated with a similar hazard of patient and graft survival. Our data of 20 years of follow-up of LDLT from a single, large Western center demonstrates excellent long-term outcomes for recipients of LDLT.
活体供肝肝移植（LDLT）是尸体供肝肝移植（DDLT）的一个有吸引力的替代方案。虽然这两种方式的短期结果相似，但长期结果尚未得到充分研究。我们比较了在加拿大最大的肝移植（LT）项目中接受LDLT的668名成年人与1596名接受DDLT者的20年结局。LDLT受者比DDLT受者显著更年轻，且男性更常见（P<0.001）。自身免疫性疾病在LDLT中更常见，而病毒性肝炎和酒精性肝病在DDLT中更常见。LDLT受者的终末期肝病模型评分更低（P=0.008），在等待名单上花费的时间更少（P<0.001），并且在LT时住院的情况更少（P<0.001）。在未调整分析中，LDLT组的1年、10年和20年患者生存率（分别为93%、74%和56%）显著高于DDLT组（分别为91%、67%和46%；对数秩检验P=0.02），LDLT组的移植物生存率（分别为91%、67%和50%）也高于DDLT组（分别为90%、65%和44.3%；对数秩检验P=0.31）。经过多变量调整后，LDLT和DDLT与患者和移植物生存的风险相似。我们来自一个单一大型西方中心对LDLT进行20年随访的数据表明，LDLT受者的长期结局良好。
