Expansion of the Liver Donor Supply Through Greater Use of Split‐Liver Transplantation: Identifying Optimal Recipients
Douglas B. Mogul
Xun Luo
Jacqueline Garonzik‐Wang
Mary G. Bowring
Allan B. Massie
Kathleen B. Schwarz
Andrew M. Cameron
John F. P. Bridges
Dorry L. Segev
First published: 19 September 2018 https://doi.org/10.1002/lt.25340
Dorry L. Segev has financial relationships from Novartis and Sanofi. Kathleen B. Schwarz has financial relationships with Gilead, Bristol‐Meyers Squibb, Roche, and Up to Date.
Douglas B. Mogul is supported by grant number 5K08HS023876‐02 from the Agency for Healthcare Research and Quality. Dorry L. Segev is supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases. Allan B. Massie is supported by grant number K01DK101677 from the National Institute of Diabetes and Digestive and Kidney Diseases.
The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of, or interpretation by, the SRTR or the US government.
Sections
ePDFPDF
Tools
Share
Abstract
The increased use of split‐liver transplantation (SLT) represents a strategy to increase the supply of organs. Although outcomes after SLT and whole liver transplantation (WLT) are similar on average among pediatric recipients, we hypothesized that the relationship between graft type and outcomes may vary depending on patient, donor, and surgical characteristics. We evaluated graft survival among pediatric (<18 years) deceased donor, liver‐only transplant recipients from March 2002 until December 2015 using data from the Scientific Registry of Transplant Recipients. Graft survival was assessed in a Cox proportional hazards model, with and without effect modification between graft type and donor, recipient, and surgical characteristics, to identify conditions where the risk of graft loss for SLT and WLT were similar. In a traditional multivariable model, characteristics associated with graft loss included donor age >50 years, recipient weight <10 kg, acute hepatic necrosis, autoimmune diseases, tumor, public insurance, and cold ischemia time (CIT) >8 hours. In an analysis that explored whether these characteristics modified the relationship between graft type and graft loss, many characteristics associated with loss actually had similar outcomes regardless of graft type, including weight <10 kg, acute hepatic necrosis, autoimmune diseases, and tumor. In contrast, several subgroups had worse outcomes when SLT was used, including recipient weight 10‐35 kg, non–biliary atresia cholestasis, and metabolic disease. Allocation score, share type, or CIT did not modify risk of graft type and graft failure. Although one might anticipate that individuals with higher rates of graft loss would be worse candidates for SLT, data suggest that these patients actually have similar rates of graft loss. These findings can guide surgical decision making and may support policy changes that promote the increased use of SLT for specific pediatric recipients. 作者: StephenW 时间: 2019-9-9 18:00
通过更多地使用分裂肝移植来扩大肝脏供体供应：确定最佳接受者
Douglas B. Mogul
荀洛
Jacqueline Garonzik-Wang
Mary G. Bowring
艾伦B.马西
Kathleen B. Schwarz
Andrew M. Cameron
John F. P. Bridges
Dorry L. Segev
首次发表：2018年9月19日 Https://doi.org/10.1002/lt.25340
Dorry L. Segev与诺华和赛诺菲有财务关系。 Kathleen B. Schwarz与Gilead，Bristol-Meyers Squibb，Roche和Up to Date有财务关系。
Douglas B. Mogul得到了医疗保健研究和质量机构的资助号5K08HS023876-02的支持。 Dorry L. Segev得到了国家糖尿病和消化和肾脏疾病研究所的资助号K24DK101828的支持。 Allan B. Massie得到了国家糖尿病和消化和肾脏疾病研究所的资助号K01DK101677的支持。
此处报告的数据由明尼阿波利斯医学研究基金会提供，作为移植受体科学登记处（SRTR）的承包商。这些数据的解释和报告是作者的责任，绝不应被视为SRTR或美国政府的官方政策或解释。
第