活体肝移植后的出院存活天数及移植物存活情况。

Days alive and out of hospital and graft survival after living donor liver transplantation.

作者信息

Oh Ah Ran, Lee Seung-Hwa, Park Jungchan, Gwak Mi Sook, Ko Justin Sangwook, Han Sangbin, Choi Gyu-Seong, Kim Jong Man, Kim Gaab Soo

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea.

出版信息

Ann Transl Med. 2023 Jun 30;11(9):308. doi: 10.21037/atm-22-6595. Epub 2023 Jun 5.

DOI:10.21037/atm-22-6595

PMID:37404994

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10316110/

Abstract

BACKGROUND

Days alive and out of hospital (DAOH) is a simple metric representing the number of days not in hospital within a defined postoperative period. In a case of mortality within the defined period, the DAOH is considered zero. DAOH has been validated in various surgical procedures, but not in living donor liver transplantation (LDLT). This study aimed to demonstrate correlation between DAOH and graft failure after LDLT.

METHODS

In this cohort study, we identified 1,335 adult-to-adult LDLT performed from June 1997 to April 2019 in our institution. We calculated DAOH at 30, 60, and 90 days among survivors and divided the recipients according to the estimated threshold of each defined period.

RESULTS

The median duration of hospital stay after LDLT in the entire population was 25 (interquartile 22-41) days. Mean DAOH of survivors at 30, 60, and 90 days were 3.3 (±3.9), 19.7 (±15.9), and 40.3 (±26.3) days, respectively. We estimated the thresholds associated with three-year graft failure for DAOH at 30, 60, and 90 days and they were 1, 12, and 42 days, respectively. The incidence of graft failure was higher in recipients with short DAOH than long DAOH (10.9% 23.6%, 10.3% 24.3%, and 9.3% 22.2% for DAOH at 30, 60, and 90 days, respectively). Among survivors at 60 days, recipients with short DAOH showed significantly higher incidence of three-year graft failure [hazard ratio (HR), 2.49; 95% confidence interval (CI): 1.86-3.34; P<0.001].

CONCLUSIONS

Considering clinical situations after LDLT, DAOH at 60 days may be a valid outcome measure.

摘要

背景

存活出院天数（DAOH）是一个简单的指标，代表在规定的术后期间内未住院的天数。在规定期间内死亡的情况下，DAOH被视为零。DAOH已在各种外科手术中得到验证，但在活体肝移植（LDLT）中尚未得到验证。本研究旨在证明LDLT后DAOH与移植失败之间的相关性。

方法

在这项队列研究中，我们确定了1997年6月至2019年4月在本机构进行的1335例成人对成人LDLT。我们计算了幸存者在30、60和90天时的DAOH，并根据每个规定期间的估计阈值对受者进行了划分。

结果

整个人群LDLT后的中位住院时间为25（四分位间距22 - 41）天。幸存者在30、60和90天时的平均DAOH分别为3.3（±3.9）天、19.7（±15.9）天和40.3（±26.3）天。我们估计了30、60和90天时与三年移植失败相关的DAOH阈值，分别为1天、12天和42天。DAOH短的受者移植失败的发生率高于DAOH长的受者（30、60和90天时DAOH的移植失败发生率分别为10.9%对23.6%、10.3%对24.3%和9.3%对22.2%）。在60天时的幸存者中，DAOH短的受者三年移植失败的发生率显著更高[风险比（HR），2.49；95%置信区间（CI）：1.86 - 3.34；P < 0.001]。