Jo Hye-Sung, Kim Dong-Sik, Cho Jai Young, Hwang Shin, Choi YoungRok, Kim Jong Man, Lee Jae Geun, You Young Kyoung, Choi Donglak, Ryu Je Ho, Kim Bong-Wan, Nah Yang Won, Ju Man Ki, Kim Tae-Seok, Suh Suk-Won
Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea.
Transplantation. 2025 Jan 1;109(1):e45-e53. doi: 10.1097/TP.0000000000005200. Epub 2024 Sep 9.
Living-donor liver transplantation has been widely performed as an alternative to the scarce liver grafts from deceased donors. More studies are reporting favorable outcomes of left liver graft (LLG). This study compared the clinical outcomes between living-donor liver transplantation using LLG and right liver graft (RLG) with similar graft-to-recipient body weight ratios.
This study analyzed 4601 patients from a multicenter observational cohort using the Korean Organ Transplantation Registry between 2014 and 2021. After matching the Model for End-stage Liver Disease score and graft-to-recipient body weight ratios because of the extremely different number in each group, the LLG and RLG groups comprised 142 (25.1%) and 423 (74.9%) patients, respectively.
For donors, the median age was higher in the LLG group than in the RLG group (34 y [range, 16-62 y] versus 30 y [16-66 y] ; P = 0.002). For recipients, the LLG group showed higher 90-d mortality than the RLG group (11 [7.7%] versus 9 [2.1%]; P = 0.004). The long-term graft survival was significantly worse in the LLG group ( P = 0.011). In multivariate Cox proportional hazards regression analysis for graft survival, LLG was not a significant risk factor (hazard ratio, 1.01 [0.54-1.87]; P = 0.980). Otherwise, donor age (≥40 y; 2.18 y [1.35-3.52 y]; P = 0.001) and recipients' body mass index (<18.5 kg/m 2 ; 2.98 kg/m 2 [1.52-5.84 kg/m 2 ]; P = 0.002) were independent risk factors for graft survival.
Although the short-term and long-term graft survival was worse in the LLG group, LLG was not an independent risk factor for graft survival in multivariate analysis. LLGs are still worth considering for selected donors and recipients regarding risk factors for graft survival.
活体肝移植作为已故供体稀缺肝脏移植的替代方法已被广泛开展。越来越多的研究报告了左肝移植（LLG）的良好结果。本研究比较了使用LLG的活体肝移植与右肝移植（RLG）且移植物与受者体重比相似情况下的临床结果。
本研究分析了2014年至2021年间来自韩国器官移植登记处多中心观察队列的4601例患者。由于每组数量差异极大，在匹配终末期肝病模型评分和移植物与受者体重比后，LLG组和RLG组分别包含142例（25.1%）和423例（74.9%）患者。
对于供体，LLG组的中位年龄高于RLG组（34岁[范围16 - 62岁]对30岁[16 - 66岁]；P = 0.002）。对于受者，LLG组90天死亡率高于RLG组（11例[7.7%]对9例[2.1%]；P = 0.004）。LLG组的长期移植物存活率显著更差（P = 0.011）。在移植物存活的多因素Cox比例风险回归分析中，LLG不是显著风险因素（风险比，1.01[0.54 - 1.87]；P = 0.980）。否则，供体年龄（≥40岁；2.18[1.35 - 3.52]；P = 0.001）和受者体重指数（<18.5kg/m²；2.98kg/m²[1.52 - 5.84kg/m²]；P = 0.002）是移植物存活的独立风险因素。
尽管LLG组的短期和长期移植物存活率更差，但在多因素分析中LLG不是移植物存活的独立风险因素。就移植物存活的风险因素而言，对于选定的供体和受者，LLG仍值得考虑。
