Thuluvath Avesh J, Peipert John, Berkowitz Rachel, Siddiqui Osama, Whitehead Bridget, Thomas Arielle, Levitsky Josh, Caicedo-Ramirez Juan, Ladner Daniela P
Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL, USA.
Dig Med Res. 2021 Sep;4. doi: 10.21037/dmr-20-151. Epub 2021 Sep 30.
Living donor liver transplantation (LDLT) provides a source for transplant in the setting of the deceased donor organ shortage. Seeing as living donors do not derive any medical benefit from the procedure, fully understanding the impact of donation on donor health-related quality of life (HRQOL) is essential. A systematic search of the MEDLINE database was performed from 2008-2020, using relevant Medical Subject Headings. Articles were evaluated for study design, cohort size and follow-up time and excluded if they contained significant methodological flaws. A total of 43 articles were included: 20 (47%) were cross-sectional and 23 (53%) were longitudinal. The mean number of donors per study was 142 (range:8-578) with follow-up ranging from 12-132 months. Forty-two unique HRQOL metrics were implemented across the 43 studies, the majority of which were questionnaires. Of the 31 studies that used the Medical Outcomes Study Short Form 36 questionnaire, 9.1% of donors reported physical QOL did not return to pre-LDLT levels for at least 2 years after donation. Mental QOL remained stable or improved after LDLT, with mean mental composite scores increasing from 50 to 52 at 3 months post-LDLT in one study. The predicted probability of poor sexual desire decreased at 1-year post-LDLT (male: 0.08, female: 0.26) relative to pre-LDLT (male: 0.44, female: 0.76; P<0.001) and three months post-LDLT (male: 0.35, female 0.69; P=0.001). Forty percent of donors found LDLT to be financially burdensome at 3 months and 19% at 2 years post-LDLT. Female gender and obesity were consistent predictors of worse HRQOL. Laparoscopy-assisted donor hepatectomy was associated with shorter hospitalizations than open donor hepatectomy (10.3 18.3 days, P=0.02). No studies used the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) measures of HRQOL. Our review demonstrates that LDLT can have a long-lasting negative impact on physical QOL in 9.1% of donors and can cause both sexual dysfunction and significant financial strain. Future studies should consider using standardized and extensively validated patient reported outcomes measures, such as PROMIS, in order to directly compare outcomes across studies and gain further insight into the impact of LDLT on D-HRQOL.
活体供肝移植（LDLT）为解决已故供体器官短缺问题提供了一种移植来源。鉴于活体供体无法从该手术中获得任何医疗益处，充分了解捐赠对供体健康相关生活质量（HRQOL）的影响至关重要。我们使用相关医学主题词对2008年至2020年的MEDLINE数据库进行了系统检索。对文章的研究设计、队列规模和随访时间进行了评估，若存在重大方法学缺陷则予以排除。共纳入43篇文章：20篇（47%）为横断面研究，23篇（53%）为纵向研究。每项研究的供体平均数量为142名（范围：8 - 578名），随访时间为12至132个月。43项研究共采用了42种独特的HRQOL指标，其中大多数是问卷。在使用医学结局研究简表36问卷的31项研究中，9.1%的供体报告称，捐赠后至少2年内身体生活质量未恢复到LDLT前的水平。LDLT后心理生活质量保持稳定或有所改善，一项研究显示，LDLT后3个月时，心理综合平均得分从50分提高到了52分。与LDLT前（男性：0.44，女性：0.76；P<0.001）和LDLT后3个月（男性：0.35，女性0.69；P = 0.001）相比，LDLT后1年性欲低下的预测概率降低（男性：0.08，女性：0.26）。40%的供体在LDLT后3个月时发现经济负担沉重，LDLT后2年时这一比例为19%。女性和肥胖是HRQOL较差的一致预测因素。腹腔镜辅助供体肝切除术与开放性供体肝切除术相比，住院时间更短（10.3对18.3天，P = 0.02）。没有研究使用美国国立卫生研究院患者报告结局测量信息系统（PROMIS）的HRQOL测量方法。我们的综述表明，LDLT可能会对9.1%的供体的身体生活质量产生长期负面影响，并可能导致性功能障碍和严重的经济压力。未来的研究应考虑使用标准化且经过广泛验证的患者报告结局测量方法，如PROMIS，以便直接比较不同研究的结果，并进一步深入了解LDLT对供体健康相关生活质量的影响。
