Magyar Christian T J, Li Zhihao, Aceituno Laia, Claasen Marco P A W, Ivanics Tommy, Choi Woo Jin, Rajendran Luckshi, Sayed Blayne A, Bucur Roxana, Rukavina Nadia, Selzner Nazia, Ghanekar Anand, Cattral Mark, Sapisochin Gonzalo
HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
Am J Transplant. 2025 Feb;25(2):406-416. doi: 10.1016/j.ajt.2024.08.011. Epub 2024 Aug 18.
Living donor liver transplantation (LDLT) is a curative treatment for various liver diseases, reducing waitlist times and associated mortality. We aimed to assess the overall survival (OS), identify predictors for mortality, and analyze differences in risk factors over time. Adult patients undergoing LDLT were selected from the United Network for Organ Sharing database from inception (1987) to 2023. The Kaplan-Meier method was used for analysis, and multivariable Cox proportional hazard models were conducted. In total, 7257 LDLT recipients with a median age of 54 years (interquartile range [IQR]: 45-61 years), 54% male, 80% non-Hispanic White, body mass index of 26.3 kg/m (IQR: 23.2-30.0 kg/m), and model for end-stage liver disease score of 15 (IQR: 11-19) were included. The median cold ischemic time was 1.6 hours (IQR: 1.0-2.3 hours) with 88% right lobe grafts. The follow-up was 4.0 years (IQR: 1.0-9.2 years). The contemporary reached median OS was 17.0 years (95% CI: 16.1, 18.1 years), with the following OS estimates: 1 year 95%; 3 years 89%; 5 years 84%; 10 years 72%; 15 years 56%; and 20 years 43%. Nine independent factors associated with mortality were identified, with an independent improved OS in the recent time era (adjusted hazards ratio: 0.53; 95% CI: 0.39, 0.71). The median center-caseload per year was 5 (IQR: 2-10), with observed center-specific improvement of OS. LDLT is a safe procedure with excellent OS. Its efficacy has improved despite an increase of risk parameters, suggesting its limits are yet to be met.
活体供肝肝移植（LDLT）是治疗各种肝脏疾病的一种治愈性方法，可减少等待名单时间及相关死亡率。我们旨在评估总生存期（OS），确定死亡预测因素，并分析不同时间风险因素的差异。从器官共享联合网络数据库中选取自创建（1987年）至2023年接受LDLT的成年患者。采用Kaplan-Meier方法进行分析，并构建多变量Cox比例风险模型。总共纳入了7257例LDLT受者，中位年龄为54岁（四分位间距[IQR]：45 - 61岁），54%为男性，80%为非西班牙裔白人，体重指数为26.3 kg/m²（IQR：23.2 - 30.0 kg/m²），终末期肝病模型评分中位数为15（IQR：11 - 19）。中位冷缺血时间为1.6小时（IQR：1.0 - 2.3小时），88%为右叶供肝。随访时间为4.0年（IQR：1.0 - 9.2年）。当代达到的中位总生存期为17.0年（95%置信区间：16.1，18.1年），总生存期估计如下：1年95%；3年89%；5年84%；10年72%；15年56%；20年43%。确定了9个与死亡相关的独立因素，近期总生存期有独立改善（调整后风险比：0.53；95%置信区间：0.39，0.71）。每年中心病例数中位数为5例（IQR：2 - 10），观察到中心特异性的总生存期改善。LDLT是一种安全的手术，总生存期良好。尽管风险参数增加，但其疗效仍有所改善，表明其极限尚未达到。
