成人间活体肝移植治疗急性肝衰竭。

Adult-to-adult living donor liver transplantation in acute liver failure.

机构信息

Vanderbilt University Medical Center, Faculty of Medicine, Department of Gastroenterology, Hepatology and Nutrition, United States of America.

Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN, United States of America.

出版信息

Transplant Rev (Orlando). 2022 Apr;36(2):100691. doi: 10.1016/j.trre.2022.100691. Epub 2022 Mar 22.

DOI:10.1016/j.trre.2022.100691

PMID:35367836

Abstract

BACKGROUND

Living Donor Liver Transplantation(LDLT) in acute liver failure(ALF) patients has been limited by concerns regarding donor safety, consent process and recipient outcomes. Our objective was to conduct a systematic review(SR) and meta-analysis to address the concerns about subpar LDLT outcomes in patients with ALF.

METHODS

We retrieved a total of 5965 literature references in our SR. United Network for Organ Sharing (UNOS) database was queried for patients over the age of 18, who underwent LDLT for "status 1" or "status 1A" listing.

RESULTS

Of 427 articles reviewed, 3 studies comprising 2574 patients (192 underwent LDLT and 2382 DDLT), were included in the meta-analysis. One, 3,5-year patient and graft survival demonstrated no difference between LDLT and DDLT group: 1-year patient survival OR1.51; 95%CI [0.58,1.90]; 1-year graft survival OR 1.19; 95%CI [0.65-2.18]; 3-year patient survival OR 0.97;95%CI [0.52-1.88]; 3-year graft survival OR 1.21 95%CI [0.67-2.16]; 5-year patient survival 0.9; 95%CI [0.37-2.20]; 5-year graft survival OR 1.30; 95%CI [0.57-2.97]. UNOS database search returned only 3 patients that underwent LDLT for ALF compared to 1562 with DDLT, precluding comparison.

CONCLUSION

One, 3, and 5-year patient and graft survival following LDLT vs DDLT transplantation were not statistically significantly different; however, due to limited number of studies further studies are warranted.

摘要

背景

活体供肝肝移植（LDLT）在急性肝衰竭（ALF）患者中的应用受到了一些因素的限制，包括对供者安全、同意过程和受者结局的担忧。我们的目的是进行系统评价（SR）和荟萃分析，以解决 ALF 患者 LDLT 结局较差的相关问题。

方法

我们在 SR 中检索到了总计 5965 篇文献。通过查询美国器官共享联合网络（UNOS）数据库，确定了年龄大于 18 岁的患者，这些患者因“状态 1”或“状态 1A”而接受 LDLT。

结果

在 427 篇综述文章中，有 3 项研究共纳入 2574 例患者（192 例接受 LDLT，2382 例接受 DDLT），纳入荟萃分析。1 年、3 年和 5 年的患者和移植物存活率在 LDLT 组和 DDLT 组之间没有差异：1 年患者存活率 OR1.51；95%CI[0.58,1.90]；1 年移植物存活率 OR1.19；95%CI[0.65-2.18]；3 年患者存活率 OR0.97；95%CI[0.52-1.88]；3 年移植物存活率 OR1.21；95%CI[0.67-2.16]；5 年患者存活率 OR0.9；95%CI[0.37-2.20]；5 年移植物存活率 OR1.30；95%CI[0.57-2.97]。UNOS 数据库搜索仅返回了 3 例因 ALF 接受 LDLT 的患者，而接受 DDLT 的患者为 1562 例，因此无法进行比较。