医学
危险系数
人口
队列
外科
置信区间
内科学
环境卫生
作者
Deok Gie Kim,Shin Hwang,Jong Man Kim,Yo Won Choi,Young Kyoung You,Dong Lak Choi,Je Ho Ryu,Bong-Wan Kim,Joo Young Kim,Jai Young Cho,Man Ki Ju,Tae‐Seok Kim,Yang Won Nah,Jae Geun Lee,Myoung Soo Kim,Dong Jin Joo
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2023-09-27
标识
DOI:10.1097/sla.0000000000006104
摘要
Objective: To compare graft survival after LDLT in patients receiving GRWR<0.8 versus GRWR≥0.8 grafts and identify risk factors for graft loss using GRWR<0.8 grafts. Summary Background Data: Favorable outcomes after living donor liver transplantation (LDLT) using graft-to-recipient weight ratio (GRWR)<0.8 grafts were recently reported; however, these results have not been validated using multicenter data. Methods: This multicentric cohort study included 3450 LDLT patients. Graft survival was compared between 1:3 propensity score–matched groups and evaluated using various Cox models in the entire population. Risk factors for graft loss with GRWR<0.8 versus GRWR≥0.8 grafts were explored within various subgroups using interaction analyses, and outcomes were stratified according to the number of risk factors. Results: In total, 368 patients (10.7%) received GRWR<0.8 grafts (GRWR<0.8 group), whereas 3082 (89.3%) received GRWR≥0.8 grafts (GRWR≥0.8 group). The 5-y graft survival rate was significantly lower with GRWR<0.8 grafts than with GRWR≥0.8 grafts (85.2% vs. 90.1%, P =0.013). Adjusted hazard ratio (HR) for graft loss using GRWR<0.8 grafts in the entire population was 1.66 (95% confidence interval [CI] 1.17–2.35, P =0.004). Risk factors exhibiting significant interactions with GRWR<0.8 for graft survival were age ≥60 y, MELD score ≥15, and male donor. When ≥2 risk factors were present, GRWR<0.8 grafts showed higher risk of graft loss compared to GRWR≥0.8 graft in LDLT (HR 2.98, 95% CI 1.79–4.88, P <0.001). Conclusions: GRWR<0.8 graft showed inferior graft survival than controls (85.2% vs. 90.1%), especially when ≥2 risk factors for graft loss (among age ≥60 y, MELD score ≥15, or male donor) were present.
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