Transplantation · 2025
Living Donor Liver Transplantation for Alcohol-related Liver Disease: An Intention-to-treat Analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Magyar Christian T J, Jones Owen, Rajendran Luckshi, Carrique Lauren, Lynch Marie-Josée, Li Zhihao, Claasen Marco P A W, Ivanics Tommy, Choi Woo Jin, Gaviria Felipe, Ghanekar Anand, Winter Erin, Bucur Roxana, Shwaartz Chaya, Reichman Trevor, Sayed Blayne A, Selzner Markus, Bhat Mamatha, Tsien Cynthia, Jaeckel Elmar, Lilly Leslie B, McGilvray Ian D, Cattral Mark S, Sapisochin Gonzalo, Selzner Nazia
Аннотация
BACKGROUND: Alcohol-associated liver disease (ALD) is the leading indication for liver transplantation (LT) in the Western world. Although 6 mo of abstinence is no longer a criterion for patients with ALD, the outcomes of living donor LT (LDLT) versus deceased donor LT (DDLT) are not well established.
METHODSS: We performed an intention-to-treat analysis to evaluate the impact of listing and pursuing primary LDLT (pLDLT) compared with primary DDLT (pDDLT). The primary endpoint was overall survival from date of listing, evaluated using Cox regression (hazard ratios).
RESULTS: Two hundred thirty-three patients with ALD were listed for LT, of which 27 (12%) were pLDLT. The overall median model for end-stage liver disease (MELD) score at listing was 20 and Na-MELD 24, a median abstinence of 4.5 mo, and 128 (55%) underwent transplantation. There was no statistically significant adjusted difference at 3-y overall survival between pLDLT versus pDDLT (adjusted hazard ratio [HR] 0.72; P = 0.550) and in the as-treated analysis (HR 1.22; P = 0.741). No patients were delisted in the pLDLT group, whereas 86 (42%) patients were delisted in the pDDLT group; primarily because of death (46 [50%]) and medical improvement (24 [28%]). Alcohol use since the time of listing was documented in 29 (13%) patients; immortal time bias adjusted analysis found no significant difference between pLDLT and pDDLT (adjusted HR 1.07; P = 0.900) and the as-treated analysis (HR 2.95; P = 0.130).
CONCLUSIONS: Patients with ALD benefit from intention pLDLT with lower rates of waitlist dropout and delisting, attributable to mortality or medical deterioration, and should be encouraged to pursue this option.
METHODSS: We performed an intention-to-treat analysis to evaluate the impact of listing and pursuing primary LDLT (pLDLT) compared with primary DDLT (pDDLT). The primary endpoint was overall survival from date of listing, evaluated using Cox regression (hazard ratios).
RESULTS: Two hundred thirty-three patients with ALD were listed for LT, of which 27 (12%) were pLDLT. The overall median model for end-stage liver disease (MELD) score at listing was 20 and Na-MELD 24, a median abstinence of 4.5 mo, and 128 (55%) underwent transplantation. There was no statistically significant adjusted difference at 3-y overall survival between pLDLT versus pDDLT (adjusted hazard ratio [HR] 0.72; P = 0.550) and in the as-treated analysis (HR 1.22; P = 0.741). No patients were delisted in the pLDLT group, whereas 86 (42%) patients were delisted in the pDDLT group; primarily because of death (46 [50%]) and medical improvement (24 [28%]). Alcohol use since the time of listing was documented in 29 (13%) patients; immortal time bias adjusted analysis found no significant difference between pLDLT and pDDLT (adjusted HR 1.07; P = 0.900) and the as-treated analysis (HR 2.95; P = 0.130).
CONCLUSIONS: Patients with ALD benefit from intention pLDLT with lower rates of waitlist dropout and delisting, attributable to mortality or medical deterioration, and should be encouraged to pursue this option.