Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea.
Department of Surgery, College of Medicine University of Ulsan, Asan Medical Center, Seoul, South Korea.
Ann Surg. 2024 Jun 1;279(6):1018-1024. doi: 10.1097/SLA.0000000000006104. Epub 2023 Sep 27.
To compare graft survival after living donor liver transplantation (LDLT) in patients receiving graft-to-recipient weight ratio (GRWR) <0.8 versus GRWR≥0.8 grafts and identify risk factors for graft loss using GRWR<0.8 grafts.
Favorable outcomes after LDLT using GRWR<0.8 grafts were recently reported; however, these results have not been validated using multicenter data.
This multicentric cohort study included 3450 LDLT patients. Graft survival was compared between 1:3 propensity score-matched groups and evaluated using various Cox models in the entire population. Risk factors for graft loss with GRWR<0.8 versus GRWR≥0.8 grafts were explored within various subgroups using interaction analyses, and outcomes were stratified according to the number of risk factors.
In total, 368 patients (10.7%) received GRWR<0.8 grafts (GRWR<0.8 group), whereas 3082 (89.3%) received GRWR≥0.8 grafts (GRWR≥0.8 group). The 5-year graft survival rate was significantly lower with GRWR<0.8 grafts than with GRWR≥0.8 grafts (85.2% vs 90.1%, P =0.013). Adjusted hazard ratio for graft loss using GRWR<0.8 grafts in the entire population was 1.66 (95% CI: 1.17-2.35, P =0.004). Risk factors exhibiting significant interactions with GRWR<0.8 for graft survival were age ≥60 years, Model for End-stage Liver Disease score ≥15, and male donor. When ≥2 risk factors were present, GRWR<0.8 grafts showed a higher risk of graft loss compared with GRWR≥0.8 graft in LDLT (hazard ratio 2.98, 95% CI: 1.79-4.88, P <0.001).
GRWR<0.8 graft showed inferior graft survival than controls (85.2% vs 90.1%), especially when ≥2 risk factors for graft loss (among age 60 years or above, Model for End-stage Liver Disease score ≥15, or male donor) were present.
比较接受供肝与受者体重比（GRWR）<0.8 的活体肝移植（LDLT）患者与接受 GRWR≥0.8 供肝的患者的移植物存活率，并确定使用 GRWR<0.8 供肝发生移植物失功的风险因素。
最近有研究报道，使用 GRWR<0.8 供肝的 LDLT 可获得良好的结果，但这些结果尚未使用多中心数据进行验证。
本多中心队列研究纳入了 3450 例 LDLT 患者。在整个研究人群中，通过 1:3 倾向评分匹配组进行移植物存活率比较，并使用各种 Cox 模型进行评估。使用交互分析在各种亚组内探讨 GRWR<0.8 与 GRWR≥0.8 供肝时移植物失功的风险因素，并根据风险因素的数量对结果进行分层。
共有 368 例患者（10.7%）接受了 GRWR<0.8 的供肝（GRWR<0.8 组），而 3082 例患者（89.3%）接受了 GRWR≥0.8 的供肝（GRWR≥0.8 组）。GRWR<0.8 组的 5 年移植物存活率明显低于 GRWR≥0.8 组（85.2%比 90.1%，P=0.013）。在整个研究人群中，使用 GRWR<0.8 供肝的移植物失功调整后的危险比为 1.66（95%CI：1.17-2.35，P=0.004）。与 GRWR<0.8 供肝的移植物存活有显著交互作用的风险因素为年龄≥60 岁、终末期肝病模型评分≥15 分和男性供者。当存在≥2 个风险因素时，与 GRWR≥0.8 供肝相比，GRWR<0.8 供肝在 LDLT 中发生移植物失功的风险更高（危险比 2.98，95%CI：1.79-4.88，P<0.001）。
与对照组（85.2%比 90.1%）相比，GRWR<0.8 供肝的移植物存活率较低，尤其是当存在≥2 个移植物失功的风险因素（年龄 60 岁或以上、终末期肝病模型评分≥15 分或男性供者）时。
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