Outcomes of Living Donor Liver Transplantation Alone for Patients on Maintenance Renal Replacement Therapy in Japan: Results of a Nationwide Survey.
Outcomes of Living Donor Liver Transplantation Alone for Patients on Maintenance Renal Replacement Therapy in Japan: Results of a Nationwide Survey.
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DOI：
10.1097/txd.0000000000000587
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发表时间：
2016-06
影响因子：
2.3
通讯作者：
Inomata Y
中科院分区：
文献类型：
--
作者：
Eguchi S;Furukawa H;Uemoto S;Umeshita K;Imamura H;Soyama A;Shimamura T;Isaji S;Ogura Y;Egawa H;Kawachi S;Kasahara M;Nagano H;Ku Y;Ohdan H;Maehara Y;Sato S;Inomata Y
由于在日本，由于死亡供体严重短缺，同时进行肝脏和肾脏移植作为一种标准做法受到限制，因此大多数接受维护性肾脏替代治疗（MRRT）的受者都需要单独进行活体供体（LD）肝移植（LTA）。对肝移植患者的MRRT进行了一项全国性的LD LTA回顾性调查。分析供体和受体的特点、术后并发症、生存率和死亡原因。成人病例28例，1年和5年总生存率分别为66.1%和57.3%。与未进行MRRT的成年人（n = 237）相比，情况明显更糟。7例患儿1年和5年总生存率均为83.3%。3名成人受体在1年后死于非动脉瘤性脑出血，1名成人受体在7个月后死于急性心力衰竭。在接受MRRT的成人受者中，移植重量与标准肝体积、LTA手术的持续时间和出血量与LD LTA术后不良预后相关。多因素分析显示，MRRT对LD LTA术后患者生存风险比最高。有MRRT的ld后LTA早期死亡率高于无MRRT的特征性病因患者。较小的移植物尺寸和复杂的手术与LD LTA后的不良预后相关。因此，成人MRRT患者的LD LTA应谨慎治疗，并进行细致的术后管理和随访。
Because simultaneous liver and kidney transplantation has been limited as a standard practice because of a severe shortage of deceased donors in Japan, living donor (LD) liver transplantation alone (LTA) is indicated in most recipients with maintenance renal replacement therapy (MRRT). A retrospective nationwide survey of LD LTA was performed for liver transplant patients on MRRT. The characteristics of donors and recipients, postoperative complications, survival rate, and causes of death were analyzed. In the adult cases (n = 28), the overall survival rate at 1 year and 5 years were 66.1% and 57.3%, respectively. When compared with those adults without MRRT (n = 237), it was significantly worse. In the 7 pediatric cases, the overall survival rate at 1 and 5 years were both 83.3%. Three adult recipients died of nonaneurysm cerebral hemorrhage after 1 year and 1 adult recipient died of acute heart failure after 7 months. In adult recipients with MRRT, graft weight versus standard liver volume, and duration and blood loss in LTA surgery were associated with poor outcomes after LD LTA. Multivariate analysis revealed that MRRT was highest hazard ratio on patient survival after LD LTA. Early post-LD LTA mortality was higher in patients with MRRT than in those without MRRT with characteristic causes. Smaller grafts for size and a complicated surgery were associated with poor outcome after LD LTA. Thus, LD LTA in adult patients on MRRT should be carefully treated with meticulous postoperative management and follow-up.