Adult Living Donor Versus Deceased Donor Liver Transplant (LDLT Versus DDLT) at a Single Center Time to Change Our Paradigm for Liver Transplant
Adult Living Donor Versus Deceased Donor Liver Transplant (LDLT Versus DDLT) at a Single Center Time to Change Our Paradigm for Liver Transplant
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DOI：
10.1097/sla.0000000000003463
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发表时间：
2019-09-01
影响因子：
9
通讯作者：
Hughes, Christopher
中科院分区：
文献类型：
--
作者：
Humar, Abhinav;Ganesh, Swaytha;Hughes, Christopher
目的：本研究的目的是在单一中心比较活体供肝移植（LDLT）和已故供肝移植（DDLT）的结果，以证明LDLT的优势，并为增加该手术的利用和应用提供理由。背景资料摘要：LDLT在美国所有肝移植中所占的比例非常小，尽管它具有优势，并且缺乏可用的死者供体器官。方法：回顾性分析在单一中心进行的所有成人LDLT （n = 245）和DDLT （n = 592）超过10年（2009-2019），通过Kaplan-Meier分析比较生存结果，并比较其他结果指标，如恢复时间、并发症、成本和资源利用。结果：LDLT受体的患者生存结果优于LDLT受体（3年生存率86% vs 80%， P = 0.03）。其他结果显示住院时间较短（11天对13天，P = 0.03），术中输血的可能性较低（52%对78%，P < 0.01），移植后透析的可能性较低（1.6%对7.4%,P < 0.01）。早期再手术和胆道/血管并发症发生率相似。低密度肝移植的住院费用降低了29.5%。活体供者并发症可接受，无早期或晚期死亡，3个月再手术率3.1%，总并发症率19.5%。鉴于其优势，我们扩大了LDLT， 2018年LDLT占移植总量的53.6%（全国平均水平4.8%），移植率从2015年的44.8例（每百人年移植率）提高到2018年的87.5例。结论：LDLT优于DDLT，包括更好的疗效和更少的资源利用。是时候改变LDLT在这个国家的使用模式了。
Objective: The aim of this study was to compare outcomes between living donor liver transplant (LDLT) and deceased donor liver transplant (DDLT) at a single center to demonstrate the advantages of LDLT and provide justification for the increased utilization and application of this procedure. Summary of Background Data: LDLT comprises a very small percentage of all liver transplants performed in the United States, this despite its advantages and a shortage of the availability of deceased donor organs. Methods: A retrospective review of all adult LDLT (n = 245) and DDLT (n = 592) performed at a single center over 10 years (2009-2019), comparing survival outcomes by Kaplan-Meier analysis and comparing other measures of outcome such as recovery times, complications, costs, and resource utilization. Results: Patient survival outcomes were superior in LDLT recipients (3-year 86% vs 80%, P = 0.03). Other outcomes demonstrated shorter length of hospital stay (11 vs 13 days, P = 0.03), less likelihood of intraoperative blood transfusion (52% vs 78%, P < 0.01), and less likelihood of need for posttransplant dialysis (1.6% vs 7.4%, P < 0.01). Early reoperation and biliary/vascular complication rates were similar. Hospital costs related to the transplant were 29.5% lower for LDLT. Complications in living donors were acceptable with no early or late deaths, 3-month reoperation rate of 3.1%, and overall complication rate of 19.5%. Given its advantages, we have expanded LDLT-in 2018, LDLT comprised 53.6% of our transplants (national average 4.8%), and our transplant rate increased from 44.8 (rate per 100-person years) in 2015 to 87.5 in 2018. Conclusions: LDLT offers advantages over DDLT including superior outcomes and less resource utilization. The time has come to change the paradigm of how LDLT is utilized in this country.