Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, St. Louis, Missouri, USA.
Organ Transplant Center, University of Iowa, Iowa City, Iowa, USA.
Clin Transplant. 2023 Jul;37(7):e14924. doi: 10.1111/ctr.14924. Epub 2023 Feb 22.
In the United States, living donor liver transplantation (LDLT) is limited to transplant centers with specific experience. However, the impact of recipient characteristics on procedure selection (LDLT vs. deceased donor liver transplant [DDLT]) within these centers has not been described. Transplant registry data for centers that performed ≥1 LDLT in 2002-2019 were analyzed using hierarchal regression modeling to quantify the impact of patient and center factors on the adjusted odds ratio (aOR) of LDLT (vs DDLT). Among 73,681 adult recipients, only 4% underwent LDLT, varying from <1% to >60% of total liver transplants. After risk adjustment, the likelihood of receiving an LDLT rose by 73% in recent years (aOR 1.73 for 2014-2019 vs. 2002-2007) but remained lower for older adults, men, racial and ethnic minorities, and obese patients. LDLT was less commonly used in patients with hepatocellular carcinoma or alcoholic cirrhosis, and more frequently in those with hepatitis C and with lower severity of illness (Model for End-Stage Liver Disease (MELD) score < 15). Patients with public insurance, lower educational achievement, and residence in the Northwest and Southeast had decreased access. While some differences in access to LDLT reflect clinical factors, further exploration into disparities in LDLT utilization based on center practice and socioeconomic determinants of health is needed.
在美国，活体供肝移植（LDLT）仅限于具有特定经验的移植中心。然而，在这些中心内，受者特征对手术选择（LDLT 与已故供体肝移植[DDLT]）的影响尚未描述。对 2002 年至 2019 年间进行了≥1 例 LDLT 的中心的移植登记数据进行了层次回归建模分析，以量化患者和中心因素对 LDLT（与 DDLT 相比）调整后的优势比（aOR）的影响。在 73681 名成年受者中，只有 4%接受了 LDLT，占总肝移植的比例从<1%到>60%不等。在风险调整后，近年来接受 LDLT 的可能性增加了 73%（2014-2019 年的 aOR 为 1.73，而 2002-2007 年为 1.73），但年龄较大、男性、种族和少数民族以及肥胖患者的可能性仍较低。LDLT 在肝细胞癌或酒精性肝硬化患者中较少使用，而在丙型肝炎患者和疾病严重程度较低（终末期肝病模型[MELD]评分<15）的患者中更为常见。有公共保险、教育程度较低以及居住在西北部和东南部的患者获得 LDLT 的机会减少。尽管 LDLT 获得机会的一些差异反映了临床因素，但仍需要进一步探讨基于中心实践和健康的社会经济决定因素的 LDLT 利用差异。
