Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2024 Apr 24;114(3b):e1366. doi: 10.7196/SAMJ.2024.v114i3b.1366.
South African transplant centres are faced with significant challenges in meeting the need for liver transplantation, owing to the low and ever-decreasing number of deceased-donor organs. To increase organ utility, deceased-donor split-liver transplant (DDSLT) and living-donor liver transplant (LDLT) programmes were initiated in the Wits Transplant Unit.
To evaluate outcomes of the LDLT and DDSLT programmes.
A retrospective analysis of de-identified recipient and donor variables from all adult and paediatric DDSLTs and LDLTs conducted between 2013 and 2021 was performed. Comparison of categorical study variables between graft types was done with the χ2 test. Continuous variables were compared by means of the independent samples t-test. Cox proportional hazards regression was performed to examine the effect of graft type on recipient and graft survival. All comparisons were made unadjusted, and adjusted for recipient age, recipient ethnicity, donor sex, and graft-weight-to-recipient-weight ratio (GWRWR) (for the paediatric cohort); and for donor age and GWRWR (for the adult cohort).
A total of 181 paediatric and 48 adult liver transplants have been performed since the inception of the two programmes. Chronic liver failure, specifically intra- and extrahepatic cholestatic disease, was our main indication for liver transplantation in both cohorts. There were no significant differences between the DDSLTs and LDLTs in respect of pre- or post-discharge intervention, in-hospital mortality, length of stay, and recipient or graft survival within both the paediatric and adult groups. Our overall 1- and 3-year survival estimates (95% confidence intervals) were 77% (70% - 83%) and 71% (64% - 78%) for the paediatric cohort, and 77% (62% - 87%) and 66% (50% - 78%) for the adult cohort, respectively.
The results of this study demonstrate comparable outcomes between DDSLT and LDLT, indicating that both methods are effective approaches to optimise organ utilisation for liver transplantation within our setting.
由于南非已故供体器官数量低且持续减少，该国的移植中心在满足肝移植需求方面面临重大挑战。为了提高器官利用率，威特大学移植科启动了已故供体劈离式肝移植（DDSLT）和活体肝移植（LDLT）项目。
评估 LDLT 和 DDSLT 项目的结果。
对 2013 年至 2021 年期间进行的所有成人和儿科 DDSLT 和 LDLT 的受者和供者变量进行回顾性分析，这些变量均经过去识别化处理。使用卡方检验比较不同移植物类型的分类研究变量。使用独立样本 t 检验比较连续变量。使用 Cox 比例风险回归分析来检查移植物类型对受者和移植物生存率的影响。所有比较均为未调整，对于儿科队列，还根据受者年龄、受者种族、供者性别和供肝重量与受者体重比（GWRWR）进行了调整；对于成人队列，还根据供者年龄和 GWRWR 进行了调整。
自这两个项目启动以来，共进行了 181 例儿科和 48 例成人肝移植。慢性肝衰竭，特别是肝内外胆汁淤积性疾病，是两个队列中肝移植的主要适应证。在儿科和成人组中，DDSLT 和 LDLT 在出院前或出院后的干预、住院死亡率、住院时间以及受者或移植物生存率方面均无显著差异。我们的总体 1 年和 3 年生存率估计值（95%置信区间）分别为儿科队列的 77%（70%83%）和 71%（64%78%），以及成人队列的 77%（62%87%）和 66%（50%78%）。
本研究结果表明 DDSLT 和 LDLT 的结果相似，表明在我们的环境中，这两种方法都是优化肝移植器官利用率的有效方法。
