Department of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Transplantation. 2024 Mar 1;108(3):713-723. doi: 10.1097/TP.0000000000004767. Epub 2023 Aug 28.
Outcomes after living-donor liver transplantation (LDLT) at high Model for End-stage Liver Disease (MELD) scores are not well characterized in the United States.
This was a retrospective cohort study using Organ Procurement and Transplantation Network data in adults listed for their first liver transplant alone between 2002 and 2021. Cox proportional hazards models evaluated the association of MELD score (<20, 20-24, 25-29, and ≥30) and patient/graft survival after LDLT and the association of donor type (living versus deceased) on outcomes stratified by MELD.
There were 4495 LDLTs included with 5.9% at MELD 25-29 and 1.9% at MELD ≥30. LDLTs at MELD 25-29 and ≥30 LDLT have substantially increased since 2010 and 2015, respectively. Patient survival at MELD ≥30 was not different versus MELD <20: adjusted hazard ratio 1.67 (95% confidence interval, 0.96-2.88). However, graft survival was worse: adjusted hazard ratio (aHR) 1.69 (95% confidence interval, 1.07-2.68). Compared with deceased-donor liver transplant, LDLT led to superior patient survival at MELD <20 (aHR 0.92; P = 0.024) and 20-24 (aHR 0.70; P < 0.001), equivalent patient survival at MELD 25-29 (aHR 0.97; P = 0.843), but worse graft survival at MELD ≥30 (aHR 1.68, P = 0.009).
Although patient survival remains acceptable, the benefits of LDLT may be lost at MELD ≥30.
在美国，高终末期肝病模型（MELD）评分的活体供肝肝移植（LDLT）的预后情况尚未得到充分描述。
这是一项回顾性队列研究，使用 2002 年至 2021 年期间仅接受首次肝移植的成人的器官获取和移植网络数据。Cox 比例风险模型评估了 MELD 评分（<20、20-24、25-29 和≥30）与 LDLT 后患者/移植物存活率的相关性，以及供体类型（活体与已故）对按 MELD 分层的结果的影响。
共纳入 4495 例 LDLT，MELD 25-29 为 5.9%，MELD≥30 为 1.9%。MELD 25-29 和≥30 的 LDLT 自 2010 年和 2015 年以来分别大幅增加。MELD≥30 的患者生存率与 MELD<20 无差异：校正风险比 1.67（95%置信区间，0.96-2.88）。然而，移植物存活率更差：校正危险比（aHR）1.69（95%置信区间，1.07-2.68）。与已故供体肝移植相比，LDLT 在 MELD<20（aHR 0.92；P=0.024）和 20-24（aHR 0.70；P<0.001）时可提高患者生存率，在 MELD 25-29 时患者生存率相当（aHR 0.97；P=0.843），但在 MELD≥30 时移植物存活率更差（aHR 1.68，P=0.009）。
尽管患者生存率仍然可以接受，但在 MELD≥30 时，LDLT 的益处可能会丧失。
