Liver transplant recipient survival benefit with living donation in the model for endstage liver disease allocation era.
Liver transplant recipient survival benefit with living donation in the model for endstage liver disease allocation era.
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DOI：
10.1002/hep.24494
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发表时间：
2011-10
期刊：
影响因子：
13.5
通讯作者：
Everhart, James E.
中科院分区：
文献类型：
--
作者：
Berg, Carl L.;Merion, Robert M.;Shearon, Tempie H.;Olthoff, Kim M.;Brown, Robert S., Jr.;Baker, Talia B.;Everson, Gregory T.;Hong, Johnny C.;Terrault, Norah;Hayashi, Paul H.;Fisher, Robert A.;Everhart, James E.
与等待死者供体肝移植 (DDLT) 相比，接受活体供体肝移植 (LDLT) 可以提高生存率。然而，对于终末期肝病模型（MELD）评分<15的患者，肝移植的生存获益受到质疑，并且在MELD分配时代，LDLT的生存优势尚未得到证实，特别是对于低MELD患者。 2002 年 2 月 28 日后登记参加成人至成人活体肝移植队列研究的移植候选人的随访时间中位数为 4.6 年。从第一个潜在活体捐献者出现时开始，根据 MELD 评分（<15 或 15+）类别和肝细胞癌（HCC）诊断，将 LDLT 接受者的死亡率与仍在等待名单上或接受 DDLT 的患者（无 LDLT 组）的死亡率进行比较。在 868 名潜在 LDLT 受者中（453 名 MELD<15；415 名入组时 MELD 15+），712 名接受移植（406 名 LDLT；306 DDLT），83 名未经移植死亡，73 名在末次随访时未经移植仍存活。总体而言，LDLT 接受者的死亡率降低了 56%（风险比 (HR)=0.44，95% 置信区间 [CI] 0.32–0.60；p<0.0001）。在没有 HCC 的候选者中，MELD<15（HR=0.39；p=0.0003）和 MELD 15+（HR=0.42；p=0.0006）均可见死亡率获益。在患有 HCC 的候选者中，对于 MELD<15（HR=0.82，p=0.65）没有看到 LDLT 的益处，但对于 MELD 15+（HR=0.29，p=0.043）却看到了 LDLT 的益处。在整个 MELD 评分范围内，没有 HCC 的患者在接受 LDLT 时获得了显着的生存获益，而不是在 MELD 肝脏分配时代等待 DDLT。患有 HCC 的低 MELD 候选人可能无法从 LDLT 中受益。
Receipt of a living donor liver transplant (LDLT) has been associated with improved survival compared with waiting for a deceased donor liver transplant (DDLT). However, the survival benefit of liver transplant has been questioned for candidates with model for end-stage liver disease (MELD) scores< 15, and the survival advantage of LDLT has not been demonstrated during the MELD allocation era, especially for low MELD patients. Transplant candidates enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study after 02/28/02 were followed for a median of 4.6 years. Starting at the time of presentation of the first potential living donor, mortality for LDLT recipients was compared to mortality for patients who remained on the waiting list or received DDLT (no LDLT group) according to categories of MELD score (<15 or 15+) and diagnosis of hepatocellular carcinoma (HCC). Of 868 potential LDLT recipients (453 with MELD<15; 415 with MELD 15+ at entry), 712 underwent transplantation (406 LDLT; 306 DDLT), 83 died without transplant, and 73 were alive without transplant at last follow-up. Overall, LDLT recipients had 56% lower mortality (hazard ratio (HR)=0.44, 95% confidence interval [CI] 0.32–0.60; p<0.0001). Among candidates without HCC, mortality benefit was seen both with MELD<15 (HR=0.39;p=0.0003) and MELD 15+ (HR=0.42;p=0.0006). Among candidates with HCC, a benefit of LDLT was not seen for MELD<15 (HR=0.82, p =0.65) but was seen for MELD 15+ (HR=0.29, p=0.043). Across the range of MELD scores, patients without HCC derived a significant survival benefit when undergoing LDLT rather than waiting for DDLT in the MELD liver allocation era. Low MELD candidates with HCC may not benefit from LDLT.
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影响因子：
29.4
作者：
Wiesner, R;Edwards, E;Krom, R
通讯作者：
Krom, R
影响因子：
13.5
作者：
Kim, WR;Therneau, TM;Dickson, ER
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作者：
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影响因子：
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作者：
Kamath, PS;Wiesner, RH;Kim, WR
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Kim, WR
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13.5
作者：
Sarasin, FP;Majno, PE;Hadengue, A
通讯作者：
Hadengue, A