Bahçelievler Memorial Hospital, Organ Transplantation Center, Istanbul, Turkey.
Bahçelievler Memorial Hospital, Department of Gastroenterology, Istanbul, Turkey.
Transplant Proc. 2023 Jun;55(5):1193-1198. doi: 10.1016/j.transproceed.2023.01.039. Epub 2023 Apr 20.
Patients with liver graft failures have an extremely low chance of finding a cadaveric graft in countries with a scarcity of deceased donors. We compared the outcomes of liver re-transplantation with living-donor liver grafts (re-LDLT) and deceased-donor liver grafts (re-DDLT) in adult patients (>18 years).
The medical records of 1513 (1417 [93.6%] LDLT and 96 [6.3%] DDLT) patients who underwent liver transplantation at Memorial Hospital between January 2011 and October 2022 were reviewed. Forty patients (24 adults and 16 pediatric) were re-transplanted (2.84%); 24 adult patients (2.72%: 25 re-LDLT, 1 patient with second re-LDLT) were divided into 2 groups: re-DDLT (n = 6) and re-LDLT (n = 18). The groups were compared in demographics, pre-, peri-, postoperative characteristics, and outcomes.
The overall survival rates were 91.7%, 79.2%, 75.0%, and 75% for <30 days, 31 to 90 days, 1, and 3 years, respectively. The LDLT group was significantly younger (P = .022), had smaller graft weight (P = .03), shorter mechanical ventilation (P = .036) but longer operation time (P = .019), and hospitalization period (P = .003). The groups were otherwise comparable. There was no statistically significant difference in survival rates between the groups (P = .058), although the re-LDLT group had an evidently higher survival rate (88.9% and 83.3 % vs 50.0%).
Re-LDLT has shown comparable outcomes to re-DDLT, if not better (even not far from significance P = .058). These results may encourage performing re-LDLTs in patients with indications for re-LT without worrying about low chances of survival, especially in countries with limited sources of deceased donors.
在死者供体稀缺的国家，肝移植失败的患者找到尸体供体的机会极低。我们比较了成人患者（>18 岁）再次接受活体供肝移植（re-LDLT）和尸体供肝移植（re-DDLT）的结果。
回顾了 2011 年 1 月至 2022 年 10 月期间在 Memorial 医院接受肝移植的 1513 名患者（1417 名 LDLT 和 96 名 DDLT）的病历。40 名患者（24 名成人和 16 名儿童）进行了再次移植（2.84%）；24 名成人患者（2.72%：25 例 re-LDLT，1 例再次接受 re-LDLT）分为 2 组：re-DDLT（n=6）和 re-LDLT（n=18）。比较两组患者的人口统计学、围手术期特征和结局。
<30 天、31-90 天、1 年和 3 年的总体生存率分别为 91.7%、79.2%、75.0%和 75%。LDLT 组患者年龄明显更小（P=0.022），移植肝脏重量更小（P=0.03），机械通气时间更短（P=0.036），但手术时间更长（P=0.019），住院时间更长（P=0.003）。两组其他方面相似。两组患者的生存率无统计学差异（P=0.058），尽管 re-LDLT 组的生存率明显更高（88.9%和 83.3% vs 50.0%）。
如果 re-LDLT 不是更好，至少与 re-DDLT 结果相当（甚至接近显著水平 P=0.058）。这些结果可能鼓励在有再次肝移植指征的患者中进行 re-LDLT，而不必担心生存率低，特别是在死者供体来源有限的国家。
