Adult to adult right lobe living donor liver transplantation: does biological relationship matter?
Adult to adult right lobe living donor liver transplantation: does biological relationship matter?
复制标题
成人对成人右叶活体肝移植：生物学关系重要吗？
DOI：
10.1097/md.0000000000004139
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发表时间：
2017-01
期刊：
影响因子：
1.6
通讯作者：
Xu M
中科院分区：
文献类型：
--
作者：
Zhang W;Tan Y;Shen S;Jiang L;Yan L;Yang J;Li B;Wen T;Zeng Y;Wang W;Xu M
活体肝移植（LDLT）中很少讨论供体和受体之间的生物学关系的影响，尽管它被认为是其他类型器官移植的重要风险因素。回顾性分析了总计272例接受成人至成人右叶LDLT的连续患者，并分层为非生物学相关（NBR）组（69例患者）和生物学相关（BR）组（203例患者）。对受体和供体的术前资料和术后结果进行评价。超过三分之二的受者有HBV感染史，肝细胞癌（HCC）是两组患者接受LDLT的主要原因。NBR组的女性供体百分比高于BR组（P = 0.000）。 两组在术后实验室检查或每日免疫抑制剂量方面没有差异，受体和供体手术的并发症发生率也没有显著差异。对于良性疾病患者，NBR组4个时期的累积1、3、5和10年生存率分别为92.9%和89.1%、87.6%、83.7%和83.7%，而对于诊断为HCC的患者，如果涉及超过米兰标准的患者，5年生存率为41.2%，而符合米兰标准的患者为82%，与良性疾病患者几乎相同。总之，我们的研究结果表明，成人间LDLT中供体和受体之间的生物学关系与诊断为良性肝病和早期HCC的受体的短期和长期结局无关。此外，诊断为HCC的患者接受LDLT的标准应严格选择。
The influence of the biological relationship between the donor and the recipient is rarely discussed in living donor liver transplantation (LDLT), although it is believed to be an important risk factor in other types of organ transplantations. A total of 272 consecutive patients undergoing adult to adult right lobe LDLT were retrospectively analyzed and stratified into a nonbiologically related (NBR) group (69 patients) and a biologically related (BR) group (203 patients). The preoperative data and postoperative outcomes of both recipients and donors were evaluated. More than two-thirds of the recipients had histories of HBV infection, and hepatocellular carcinoma (HCC) was the main reason for the patients undergoing LDLT in both groups. The percentage of female donors in the NBR group was more than the percentage in the BR group (P = 0.000). There were no differences between the groups in postoperative laboratory testing or daily immunosuppression dose, and the complication rates in both the recipient and donor surgeries showed no significant differences. For patients with benign diseases, the cumulative 1-, 3-, 5-, and 10-year survival rate were 92.9% in the 4 periods in the NBR group and 89.1%, 87.6%, 83.7%, and 83.7%, respectively, in BR group, while for the patients diagnosed as HCC, if patients exceeding the Milan criteria were involved, the 5-year survival rate was 41.2%, compared to 82% for patients within the Milan criteria, which was nearly the same as for those with the benign disease. In conclusion, our findings suggested that the biological relationship between the donor and the recipient in adult to adult LDLT was not associated with the short- and long-term outcomes of recipients diagnosed with benign liver diseases and early stage HCC. Moreover, the criteria for patients diagnosed with HCC to undergo LDLT should be restrictively selected.