Alqahtani Saleh A, Gurakar Ahmet, Tamim Hani, Schiano Thomas D, Bonder Alan, Fricker Zachary, Kazimi Marwan, Eckhoff Devin E, Curry Michael P, Saberi Behnam
Johns Hopkins University, Division of Gastroenterology and Hepatology, Baltimore, MD, USA.
American University of Beirut, Department of Internal Medicine, Beirut, Lebanon.
J Clin Transl Hepatol. 2022 Oct 28;10(5):814-824. doi: 10.14218/JCTH.2021.00538. Epub 2022 Apr 6.
Liver organ shortage remains a major health burden in the US, with more patients being waitlisted than the number of liver transplants (LTs) performed. This study investigated US national and regional trends in living donor LT (LDLT) and identified factors associated with recipient survival.
We retrospectively analyzed LDLT recipients and donors from the United Network Organ Sharing/Organ Procurement Transplant Network database from 1998 until 2019 for clinical characteristics, demographic differences, and survival rate. National and regional trends in LDLT, recipient outcomes, and predictors of survival were analyzed.
Of the 223,571 candidates listed for an LT, 57.5% received an organ, of which only 4.2% were LDLTs. Annual adult LDLTs first peaked at 412 in 2001 but experienced a significant decline to 168 by 2009. LDLTs then gradually increased to 445 in 2019. Region 2 had the highest LDLT numbers (=919), while region 1 had the highest proportion (11.1%). Overall, post-LT mortality was 21.4% among LDLT recipients. Post-LDLT survival rates after 1-, 5-, and 10-years were 92%, 87%, and 70%, respectively. Interval analysis (2004-2019) showed that patients undergoing LDLT in recent years had lower mortality than in earlier years (hazard ratio=0.81, 95% confidence interval=0.75-0.88).
Following a substantial decline after a peak in 2001, the number of adult LDLTs steadily increased from 2011 to 2019. However, LDLTs still constitute the minority of the transplant pool in the US. Life-saving policies to increase the use of LDLTs, particularly in regions of high organ demand, should be implemented.
在美国，肝脏器官短缺仍然是一项重大的健康负担，等待肝脏移植的患者人数超过了实际进行肝脏移植（LT）的数量。本研究调查了美国活体供肝肝移植（LDLT）的全国和地区趋势，并确定了与受者生存相关的因素。
我们回顾性分析了1998年至2019年来自器官共享联合网络/器官获取与移植网络数据库的LDLT受者和供者的临床特征、人口统计学差异和生存率。分析了LDLT的全国和地区趋势、受者结局及生存预测因素。
在223571名等待LT的候选人中，57.5%的人接受了器官移植，其中只有4.2%是LDLT。成人LDLT的年度数量在2001年首次达到峰值412例，但到2009年大幅下降至168例。随后，LDLT数量逐渐增加，到2019年达到445例。第2地区的LDLT数量最多（=919例），而第1地区的比例最高（11.1%）。总体而言，LDLT受者的肝移植后死亡率为21.4%。LDLT后1年、5年和10年的生存率分别为92%、87%和70%。区间分析（2004 - 2019年）显示，近年来接受LDLT的患者死亡率低于早年（风险比=0.81，95%置信区间=0.75 - 0.88）。
在2001年达到峰值后大幅下降之后，成人LDLT的数量从2011年到2019年稳步增加。然而，LDLT在美国移植库中仍占少数。应实施旨在增加LDLT使用的救命政策，特别是在器官需求高的地区。
