Survival Benefit of Split-Liver Transplantation for Pediatric and Adult Candidates.
Survival Benefit of Split-Liver Transplantation for Pediatric and Adult Candidates.
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DOI：
10.1002/lt.26393
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发表时间：
2022-06
影响因子：
4.6
通讯作者：
Mogul, Douglas B.
中科院分区：
文献类型：
--
作者：
Bowring, Mary G.;Massie, Allan B.;Schwarz, Kathleen B.;Cameron, Andrew M.;King, Elizabeth A.;Segev, Dorry L.;Mogul, Douglas B.
在儿童和成人受者中，全肝移植（WLT）与分肝移植（SLT）后患者和移植物存活率相似，但很少使用SLT。我们试图确定与接受可分割移植物提供的存活率相关的益处，而不是使用2010年至2018年的移植受体科学登记处（SRTR）数据，928名儿童和1814名曾接受可分割移植物的成人肝移植候选人。我们比较了接受与拒绝分割肝脏的患者的最终死亡率，无论随后的移植如何，调整了儿科终末期肝病/终末期肝病模型（MELD）评分，诊断和儿科候选人的体重，并匹配了MELD评分，身高和成人候选人的报价。在≤7 kg的儿科候选人中，接受与拒绝分割肝脏与死亡率降低63%相关（调整后风险比[aHR]，0.170.370.80 [P = 0.01];决定后1年生存率分别为93.1%和84.0%）。在体重下降≤7 kg的受试者中，6.4%死亡，31.1%接受了WLT。在>7 kg的儿科候选人中，接受分割肝脏的相关性无显著差异（aHR，0.631.071.82 [P = 0.81];决定后1年生存率为91.7% vs 94.4%）。在体重下降>7 kg的1年内，1.8%的人死亡，45.8%的人接受了WLT。在成年候选人中，接受分割肝脏与死亡率降低43%相关（aHR，0.390.570.83 [P = 0.005];决定后1年生存率为92.2% vs 84.4%）。在成年候选人下降的1年内，7.9%死亡，39.3%接受了WLT。接受分割肝脏的治疗可以显着提高等待名单上的儿童和成人的生存率。
Patient and graft survival are similar following whole-liver transplantations (WLTs) versus split-liver transplantations (SLTs) among pediatric and adult recipients, yet SLTs are rarely used. We sought to determine the survival benefit associated with accepting a splittable graft offer for SLT versus declining and waiting for a subsequent offer using 2010 to 2018 Scientific Registry of Transplant Recipients (SRTR) data on 928 pediatric and 1814 adult liver transplantation candidates who were ever offered a splittable graft. We compared eventual mortality, regardless of subsequent transplants, between those patients who accepted versus declined a split liver offer with adjustments for Pediatric End-Stage Liver Disease/Model for End-Stage Liver Disease (MELD) scores, diagnosis, and weight among pediatric candidates and matching for MELD score, height, and offer among adult candidates. Among pediatric candidates ≤7 kg, split liver offer acceptance versus decline was associated with a 63% reduction in mortality (adjusted hazard ratio [aHR], 0.170.370.80 [P = 0.01]; 93.1% versus 84.0% 1-year survival after decision). Within 1 year of decline for those ≤7 kg, 6.4% died and 31.1% received a WLT. Among pediatric candidates >7 kg, there was no significant difference associated with acceptance of a split liver offer (aHR, 0.631.071.82 [P = 0.81]; 91.7% versus 94.4% 1-year survival after decision). Within 1 year of decline for those >7 kg, 1.8% died and 45.8% received a WLT. Among adult candidates, split liver offer acceptance was associated with a 43% reduction in mortality (aHR, 0.390.570.83 [P = 0.005]; 92.2% versus 84.4% 1-year survival after decision). Within 1 year of decline for adult candidates, 7.9% died and 39.3% received a WLT. Accepting split liver offers for SLT could significantly improve survival for small children and adults on the waiting list.
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影响因子：
9
作者：
Diamond, Ivan R.;Fecteau, Annie;Song, Changhong
通讯作者：
Song, Changhong
影响因子：
4.6
作者：
Sasaki, Kazunari;Firl, Daniel J.;Hashimoto, Koji
通讯作者：
Hashimoto, Koji
DOI：
10.1111/ajt.12777
发表时间：
2014-08
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Massie AB;Kucirka LM;Segev DL
通讯作者：
Segev DL
影响因子：
8.8
作者：
Lai, J. C.;Terrault, N. A.;Biggins, S. W.
通讯作者：
Biggins, S. W.
影响因子：
6.2
作者：
Perito, Emily R.;Roll, Garrett;Roberts, John P.
通讯作者：
Roberts, John P.