The Practice of Retransplantation for Recurrent Alcohol-associated Liver Disease in the United States Is Uncommon With Acceptable Outcomes.
The Practice of Retransplantation for Recurrent Alcohol-associated Liver Disease in the United States Is Uncommon With Acceptable Outcomes.
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DOI：
10.1097/txd.0000000000001297
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发表时间：
2022-03
影响因子：
2.3
通讯作者：
Mitchell MC
中科院分区：
文献类型：
--
作者：
Cotter TG;Odenwald MA;Lieber SR;Rich NE;Im G;Charlton M;Singal AG;Mitchell MC
酒精相关性肝病（ALD）是美国肝移植（LT）的主要适应症。酒精使用障碍复发可导致移植失败和需要再次肝移植（re-LT）。尽管肝移植治疗ALD的发病率不断上升，但对复发性ALD的再肝移植实践还不清楚。我们的目的是确定在过去20年中复发性ALD的re-LT实践。使用美国国家移植登记处，将因复发性ALD而接受re-LT的成人与死于复发性ALD的LT受者和倾向评分匹配的非ALD适应症的re-LT受者进行比较。所有组的原发性移植物均存活至少1年。Kaplan-Meier分析用于计算1年和5年生存率。在2000年至2020年期间，对复发性ALD进行了74次重新LT（占所有重新LT的1.0%）。从2017年到2020年，与2014年到2016年相比，经常性ALD re-LT实践有所增加（20比2）。在re-LT时，复发ALD患者的体重指数显著降低（中位数25.1对28.8 kg/m2; P < 0.001）与LT指数相比。接受ALD和非ALD再LT的患者的患者和移植物存活率相似（56.4% vs 56.9% 5年移植物存活率，P = 0.96; 62.8% vs 59.0% 5年患者存活率，P = 0.58）。在美国，对复发性ALD进行重新LT的做法并不常见。移植物和患者存活率似乎是可以接受的，并且支持如果患者被认为是合适的候选人，则偶尔对复发性ALD进行re-LT。
Alcohol-associated liver disease (ALD) is the leading indication for liver transplantation (LT) in the United States. Alcohol use disorder relapse can lead to graft failure and the need for liver retransplantation (re-LT). Despite the rising incidence of LT for ALD, the practice of re-LT for recurrent ALD is not well understood. We aimed to define the practice of re-LT for recurrent ALD during the last 20 y. Using the US national transplant registry, adults who underwent re-LT for recurrent ALD were compared with LT recipients who died from recurrent ALD and propensity score–matched re-LT recipients with non-ALD indications. All groups had at least 1-y survival of their primary graft. Kaplan-Meier analysis was used to calculate 1- and 5-y survivals. Between 2000 and 2020, 74 re-LTs were performed for recurrent ALD (1.0% of all re-LTs). There was an increase in recurrent ALD re-LT practice from 2017 to 2020 versus 2014 to 2016 (20 versus 2). At the time of re-LT, patients with recurrent ALD had a significant decrease in body mass index (median 25.1 versus 28.8 kg/m2; P < 0.001) versus the index LT. Patient and graft survivals were similar between patients who underwent re-LT for ALD and non-ALD (56.4% versus 56.9% 5-y graft survival, P = 0.96; 62.8% versus 59.0% 5-y patient survival, P = 0.58). The practice of re-LT for recurrent ALD is uncommon in the United States. Graft and patient survivals seem to be acceptable and support the occasional practice of re-LT for recurrent ALD should the patient be deemed an appropriate candidate.