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Survival after live donor versus deceased donor liver transplantation: propensity score-matched study.
Kaltenmeier, Christof; Liu, Hao; Zhang, Xingyu; Ganoza, Armando; Crane, Andrew; Powers, Colin; Gunabushanam, Vikraman; Behari, Jaideep; Molinari, Michele.
Afiliación
  • Kaltenmeier C; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Liu H; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Zhang X; School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Ganoza A; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Crane A; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Powers C; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Gunabushanam V; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Behari J; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Molinari M; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
BJS Open ; 8(3)2024 May 08.
Article en En | MEDLINE | ID: mdl-38837956
ABSTRACT

BACKGROUND:

For individuals with advanced liver disease, equipoise in outcomes between live donor liver transplant (LDLT) and deceased donor liver transplant (DDLT) is uncertain.

METHODS:

A retrospective cohort study was performed using data extracted from the Scientific Registry of Transplant Recipients. Adults who underwent first-time DDLT or LTDL in the United States between 2002 and 2020 were paired using propensity-score matching with 110 ratio without replacement. Patient and graft survival were compared using the model for end-stage liver disease (MELD) score for stratification.

RESULTS:

After propensity-score matching, 31 522 DDLT and 3854 LDLT recipients were included. For recipients with MELD scores ≤15, LDLT was associated with superior patient survival (HR = 0.92; 95% c.i. 0.76 to 0.96; P = 0.013). No significant differences in patient survival were observed for MELD scores between 16 and 30. Conversely, for patients with MELD scores >30, LDLT was associated with higher mortality (HR 2.57; 95% c.i. 1.35 to 4.62; P = 0.003). Graft survival was comparable between the two groups for MELD ≤15 and for MELD between 21 and 30. However, for MELD between 16 and 20 (HR = 1.15; 95% c.i. 1.00 to 1.33; P = 0.04) and MELD > 30 (HR = 2.85; 95% c.i. 1.65 to 4.91; P = 0.001), graft survival was considerably shorter after LDLT. Regardless of MELD scores, re-transplantation rate within the first year was significantly higher after LDLT.

CONCLUSIONS:

In this large propensity score-matched study using national data, comparable patient survival was found between LDLT and DDLT in recipients with MELD scores between 16 and 30. Conversely, for patients with MELD > 30, LDLT was associated with worse outcomes. These findings underscore the importance of transplant selection for patients with high MELD scores.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Hígado / Donadores Vivos / Puntaje de Propensión / Supervivencia de Injerto Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: BJS Open Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Hígado / Donadores Vivos / Puntaje de Propensión / Supervivencia de Injerto Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: BJS Open Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido