Medina-Morales Esli, Ismail Mohamed, Barba Bernal Romelia, Abboud Yazan, Sierra Leandro, Marenco-Flores Ana, Goyes Daniela, Saberi Behnam, Patwardhan Vilas, Bonder Alan
Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA.
Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
J Clin Med. 2023 Oct 15;12(20):6536. doi: 10.3390/jcm12206536.
Primary biliary cholangitis (PBC) prompts liver transplantation (LT) due to cholestasis, cirrhosis, and liver failure. Despite lower MELD scores, recent studies highlight higher PBC waitlist mortality, intensifying the need for alternative transplantation strategies. Living donor liver transplant (LDLT) has emerged as a solution to the organ shortage. This study compares LDLT and deceased donor liver transplant (DDLT) outcomes in PBC patients via retrospective analysis of the UNOS database (2002-2021). Patient survival, graft failure, and predictors were evaluated through Kaplan-Meier and Cox-proportional analyses. Among 3482 DDLTs and 468 LDLTs, LDLT showed superior patient survival (92.3%, 89.1%, 87.6%, 85.0%, 77.2% vs. 91.5%, 88.3%, 86.3%, 82.2%, 71.0%; respectively; = 0.02) with no significant graft survival difference at 1-, 2-, 3-, 5-, and 10-years post-LT (91.0%, 88.0%, 85.7%, 83.0%, 75.4% vs. 90.5%, 87.4%, 85.3%, 81.3%, 70.0%; respectively; = 0.06). Compared to DCD, LDLT showed superior patient and graft survival ( < 0.05). Younger male PBC recipients with a high BMI, diabetes, and dialysis history were associated with mortality and graft failure ( < 0.05). Our study showed that LDLT had superior patient survival to DDLT. Predictors of poor post-LT outcomes require further validation studies.
原发性胆汁性胆管炎（PBC）可因胆汁淤积、肝硬化和肝衰竭而促使患者接受肝移植（LT）。尽管终末期肝病模型（MELD）评分较低，但近期研究表明，PBC患者在等待移植名单上的死亡率较高，这凸显了对替代移植策略的需求。活体供肝移植（LDLT）已成为解决器官短缺问题的一种方案。本研究通过对器官共享联合网络（UNOS）数据库（2002 - 2021年）进行回顾性分析，比较了PBC患者接受LDLT和尸体供肝移植（DDLT）的结局。通过Kaplan - Meier分析和Cox比例分析评估患者生存率、移植物失败情况及预测因素。在3482例DDLT和468例LDLT中，LDLT显示出更好的患者生存率（分别为92.3%、89.1%、87.6%、85.0%、77.2% 与91.5%、88.3%、86.3%、82.2%、71.0%；P = 0.02），在LT后1年、2年、3年、5年和10年时移植物生存率无显著差异（分别为91.0%、88.0%、85.7%、83.0%、75.4% 与90.5%、87.4%、85.3%、81.3%、70.0%；P = 0.06）。与心死亡器官捐献（DCD）相比，LDLT显示出更好的患者和移植物生存率（P < 0.05）。BMI高、患有糖尿病且有透析史的年轻男性PBC受者与死亡率和移植物失败相关（P < 0.05）。我们的研究表明，LDLT的患者生存率优于DDLT。LT后不良结局的预测因素需要进一步的验证研究。
