Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA.
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA.
Am J Transplant. 2023 Feb;23(2 Suppl 1):S178-S263. doi: 10.1016/j.ajt.2023.02.006.
In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569 (6.2%) from living donors. There were 8,733 (94.6%) adult and 501 (5.4%) pediatric liver transplant recipients. An increase in the number of deceased donor livers corresponded to an increase in the overall transplant rate and shorter waiting times, although still 10.0% of livers that were recovered were not transplanted. Alcohol-associated liver disease was the leading indication for both waitlist registration and liver transplant in adults, outpacing nonalcoholic steatohepatitis, while biliary atresia remained the leading indication for children. Related to allocation policy changes implemented in 2019, the proportion of liver transplants performed for hepatocellular carcinoma has decreased. Among adult candidates listed for liver transplant in 2020, 37.7% received a deceased donor liver transplant within 3 months, 43.8% within 6 months, and 53.3% within 1 year. Pretransplant mortality improved for children following implementation of acuity circle-based distribution. Short-term graft and patient survival outcomes up to 1 year worsened for adult deceased and living donor liver transplant recipients, which is a reversal of previous trends and coincided with the onset of the COVID-19 pandemic in early 2020. Longer-term outcomes among adult deceased donor liver transplant recipients were unaffected, with overall posttransplant mortality rates of 13.3% at 3 years, 18.6% at 5 years, and 35.9% at 10 years. Pretransplant mortality improved for children following implementation of acuity circle-based distribution and prioritization of pediatric donors to pediatric recipients in 2020. Pediatric living donor recipients had superior graft and patient survival outcomes compared with deceased donor recipients at all time points.
2021 年，肝移植数量继续增长，美国共进行了 9234 例肝移植，其中 8665 例（93.8%）来自已故供体，569 例（6.2%）来自活体供体。接受肝移植的患者中 8733 例为成人，501 例为儿童。已故供体肝脏数量的增加对应着整体移植率的提高和等待时间的缩短，尽管仍有 10.0%的已回收肝脏未进行移植。酒精相关性肝病是成人进行肝移植登记和肝移植的首要原因，超过了非酒精性脂肪性肝炎，而胆道闭锁仍然是儿童肝移植的首要原因。与 2019 年实施的分配政策变化有关，用于治疗肝细胞癌的肝移植比例有所下降。2020 年，在等待肝移植的成年患者中，有 37.7%在 3 个月内、43.8%在 6 个月内和 53.3%在 1 年内接受了已故供体肝移植。实行基于病情严重程度的分配制度后，儿童患者的移植前死亡率有所改善。成人已故供体和活体供体肝移植受者的短期移植物和患者生存率在 1 年内有所恶化，这与之前的趋势相反，与 2020 年初 COVID-19 大流行的开始同时发生。成人已故供体肝移植受者的长期预后不受影响，术后 3 年、5 年和 10 年的总体移植后死亡率分别为 13.3%、18.6%和 35.9%。2020 年实行基于病情严重程度的分配制度，并优先考虑将儿科供体分配给儿科受者后，儿童患者的移植前死亡率有所改善。在所有时间点，儿科活体供体受者的移植物和患者生存率均优于已故供体受者。
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