Kumar Shiva, Lin Songhua, Schold Jesse D
Department of Gastroenterology and Hepatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA.
Hepatol Int. 2025 Feb;19(1):244-255. doi: 10.1007/s12072-024-10733-y. Epub 2024 Oct 30.
Limited data exists regarding impact of graft type on outcomes following liver transplantation (LT) in Primary Sclerosing Cholangitis (PSC). Our goal was to evaluate the impact of graft type on outcomes following LT in PSC and determine predictors of outcomes.
Using the Scientific registry of transplant recipients (SRTR), retrospective cohorts were constructed of recipients with PSC over the time period 2010-2020, divided into 2 eras: 2010-2014, 2015-2020, stratified by graft type: living donor (LDLT), donation after circulatory death (DCD) and donation after brain death (DBD). Outcome measures evaluated were graft and patient survival. Survival comparison was performed using Kaplan-Meier method and multivariable analysis using Cox proportional hazard models.
2966 recipients underwent LT for PSC over the study period: LDLT-PSC 153 (5.2%), DCD-PSC 131 (4.4%) and DBD-PSC 2682 (90.4%). While LDLT utilization was higher in PSC (5.2% vs. 1.3%; p < 0.001), DCD use was lower (4.4% vs. 7.2%; p < 0.001) but increased over time (era 1 vs. era 2: 3.3% vs. 5.2%; p = 0.02). Outcomes following DCD-PSC were comparable to DBD and improved over time. Compared to DBD-PSC, there was a trend toward lower short-term graft survival following LDLT-PSC (1 Yr. 85.3 vs. 91.9; p = 0.07) with higher retransplant rate (LDLT-PSC vs. DCD-PSC vs. DBD-PSC: 15% vs 11% vs 7%; p < 0.001). Compared to recipients without PSC, long-term patient survival was superior in LDLT-PSC (5 Yr. 90.1 vs. 83.7%; p = 0.05) and DCD-PSC (93.3 vs. 79.7%, p = 0.01). On multivariable analysis, LDLT but not DCD graft type, was associated with inferior graft survival in PSC (adjusted hazard Ratio = 1.65 (1.16-2.34); p = 0.005).
In PSC, utilization of LDLT is higher, while DCD use is lower but increased over time. Outcomes following DCD LT in PSC are comparable to DBD and superior to recipients without PSC. Reduced graft survival and higher re-transplant rate following LDLT in PSC warrants further study. Consideration of DCD could help expand the donor pool in PSC.
关于原发性硬化性胆管炎（PSC）患者肝移植（LT）后移植物类型对预后的影响，现有数据有限。我们的目标是评估移植物类型对PSC患者LT后预后的影响，并确定预后的预测因素。
利用移植受者科学注册系统（SRTR），构建了2010年至2020年期间PSC受者的回顾性队列，分为两个时代：2010 - 2014年、2015 - 2020年，按移植物类型分层：活体供肝（LDLT）、循环死亡后捐赠（DCD）和脑死亡后捐赠（DBD）。评估的结局指标为移植物和患者生存率。采用Kaplan - Meier方法进行生存比较，并使用Cox比例风险模型进行多变量分析。
在研究期间，2966例患者接受了PSC的LT：LDLT - PSC 153例（5.2%），DCD - PSC 131例（4.4%），DBD - PSC 2682例（90.4%）。虽然PSC中LDLT的使用率较高（5.2%对1.3%；p < 0.001），DCD的使用率较低（4.4%对7.2%；p < 0.001），但随时间增加（时代1对时代2：3.3%对5.2%；p = 0.02）。DCD - PSC后的结局与DBD相当，且随时间改善。与DBD - PSC相比，LDLT - PSC后短期移植物生存率有降低趋势（1年时85.3%对91.9%；p = 0.07），再移植率更高（LDLT - PSC对DCD - PSC对DBD - PSC：15%对11%对7%；p < 0.001）。与无PSC受者相比，LDLT - PSC（5年时90.1%对83.7%；p = 0.05）和DCD - PSC（93.3%对79.7%，p = 0.01）的长期患者生存率更高。多变量分析显示，LDLT而非DCD移植物类型与PSC中较差的移植物生存率相关（调整后风险比 = 1.65（1.16 - 2.34）；p = 0.005）。
在PSC中，LDLT的使用率较高，而DCD的使用率较低但随时间增加。PSC中DCD LT后的结局与DBD相当，且优于无PSC受者。PSC中LDLT后移植物生存率降低和再移植率更高值得进一步研究。考虑DCD有助于扩大PSC的供体库。
