When Living Donor Liver Allografts Fail: Exploring the Outcomes of Retransplantation Using Deceased Donors
When Living Donor Liver Allografts Fail: Exploring the Outcomes of Retransplantation Using Deceased Donors
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当活体捐献者同种异体肝脏移植失败时：探索使用已故捐献者进行再移植的结果
DOI：
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发表时间：
2017
影响因子：
8.8
通讯作者：
David S. Goldberg
中科院分区：
文献类型：
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作者：
T. Bittermann;Abraham Shaked;David S. Goldberg
首次活体肝移植（LDLT）后再次移植的结局知之甚少。本研究的目的是更好地了解初始LDLT后与初始死者供体移植（DDLT）后再次移植的适应症、时机和结果。从2002年到2013年，在器官获取和移植网络/器官共享联合网络中确定了209名初次LDLT后的再次移植受者和2893名初次DDLT后的再次移植受者。多变量logistic模型评估了初始移植类型与1年死亡率之间的相关性。LDLT受者中早期移植物失败（≤14天）的最常见原因是血管血栓形成（63.6%），而初始DDLT受者中的原发性移植物失败（59.1%）。再次移植时，LDLT受者更常为急性和/或危重病，状态1（42.6% vs. 27.3%; p < 0.001）和重症监护室（52.2% vs. 39.9%; p = 0.001）受者的比例更高。初次LDLT与DDLT后再移植受者之间的校正1年死亡率无差异（比值比0.74; 95%置信区间0.51-1.08）。两组最终需要第三次再次移植的受者比例没有差异（4.8%）。LDLT后的再次移植结果与其他再次移植程序没有不同，尽管受者具有更大的病情和不同的适应症。
Outcomes of retransplantation after initial living donor liver transplantation (LDLT) are poorly understood. The aim of this study is to better understand the indications, timing, and outcomes of retransplantation after initial LDLT when compared to after initial deceased donor transplantation (DDLT). From 2002 to 2013, 209 retransplant recipients after initial LDLT and 2893 after initial DDLT were identified in Organ Procurement and Transplantation Network/United Network for Organ Sharing. Multivariable logistic models evaluated the association between initial transplant type and 1‐year mortality. The most frequent reason for early graft failure (≤14 days) in LDLT recipients was vascular thrombosis (63.6%) versus primary graft failure in initial DDLT recipients (59.1%). LDLT recipients were more often acutely and/or critically ill with a greater proportion of Status 1 (42.6% vs. 27.3%; p < 0.001) and intensive care unit (52.2% vs. 39.9%; p = 0.001) recipients at the time of retransplantation. There was no difference in adjusted 1‐year mortality between retransplant recipients after initial LDLT versus DDLT (odds ratio 0.74; 95% confidence interval 0.51–1.08). The proportion of recipients who ultimately required retransplantation for a third time was not different between the two groups (4.8%). Retransplantation outcomes after LDLT are not different from other retransplant procedures, despite recipients having greater acuity of illness and different indications.