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活体供肝肝移植与原发性硬化性胆管炎患者移植后生存率的提高

Living-Donor Liver Transplant and Improved Post-Transplant Survival in Patients with Primary Sclerosing Cholangitis.

作者信息

Sierra Leandro, Barba Romelia, Ferrigno Bryan, Goyes Daniela, Diaz Wilfor, Patwardhan Vilas R, Saberi Behnam, Bonder Alan

机构信息

Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

出版信息

J Clin Med. 2023 Apr 11;12(8):2807. doi: 10.3390/jcm12082807.

Abstract

Primary sclerosing cholangitis (PSC) is the leading indication of liver transplantation (LT) among autoimmune liver disease patients. There is a scarcity of studies comparing survival outcomes between living-donor liver transplants (LDLT)s and deceased-donor liver transplants (DDLTs) in this population. Using the United Network for Organ Sharing database, we compared 4679 DDLTs and 805 LDLTs. Our outcome of interest was post-LT patient survival and post-LT graft survival. A stepwise multivariate analysis was performed, adjusting for recipient age, gender, diabetes mellitus, ascites, hepatic encephalopathy, cholangiocarcinoma, hepatocellular carcinoma, race, and the model for end-stage liver disease (MELD) score; donor' age and sex were also included to the analysis. According to univariate and multivariate analysis, LDLT had a patient and graft survival benefit compared to DDLT (HR, 0.77, 95% CI 0.65-0.92; < 0.002). LDLT patient survival (95.2%, 92.6%, 90.1%, and 81.9%) and graft survival (94.1%, 91.1%, 88.5%, and 80.5%) at 1, 3, 5, and 10 years were significantly better than DDLT patient survival (93.2%, 87.6%, 83.3%, and 72.7%) and graft survival (92.1%, 86.5%, 82.1%, and 70.9%) ( < 0.001) in the same interval. Variables including donor and recipient age, male recipient gender, MELD score, diabetes mellitus, hepatocellular carcinoma, and cholangiocarcinoma were associated with mortality and graft failure in PSC patients. Interestingly, Asians were more protected than Whites (HR, 0.61; 95% CI, 0.35-0.99; < 0.047), and cholangiocarcinoma was associated with the highest hazard of mortality (HR, 2.07; 95% CI, 1.71-2.50; < 0.001) in multivariate analysis. LDLT in PSC patients were associated with greater post-transplant patient and graft survival compared to DDLT patients.

摘要

原发性硬化性胆管炎(PSC)是自身免疫性肝病患者中肝移植(LT)的主要指征。在这一人群中,比较活体供肝肝移植(LDLT)和尸体供肝肝移植(DDLT)生存结局的研究较少。我们使用器官共享联合网络数据库,比较了4679例DDLT和805例LDLT。我们感兴趣的结局是肝移植术后患者生存和肝移植术后移植物生存。进行了逐步多变量分析,对受者年龄、性别、糖尿病、腹水、肝性脑病、胆管癌、肝细胞癌、种族以及终末期肝病模型(MELD)评分进行了校正;供者年龄和性别也纳入了分析。根据单变量和多变量分析,与DDLT相比,LDLT在患者和移植物生存方面具有优势(HR,0.77;95%CI,0.65 - 0.92;<0.002)。PSC患者1年、3年、5年和10年的LDLT患者生存率(95.2%、92.6%、90.1%和81.9%)和移植物生存率(94.1%、91.1%、88.5%和80.5%)显著优于同期DDLT患者的生存率(93.2%、87.6%、83.3%和72.7%)和移植物生存率(92.1%、86.5%、82.1%和70.9%)(<0.001)。包括供者和受者年龄、男性受者性别、MELD评分、糖尿病、肝细胞癌和胆管癌在内的变量与PSC患者的死亡率和移植物失败相关。有趣的是,在多变量分析中,亚洲人比白人受到的保护更多(HR,0.61;95%CI,0.35 - 0.99;<0.047),并且胆管癌与最高的死亡风险相关(HR,2.07;95%CI,1.71 - 2.50;<0.001)。与DDLT患者相比,PSC患者接受LDLT后患者和移植物的术后生存率更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0395/10145248/7c3454d1e565/jcm-12-02807-g001.jpg

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