Living donor liver transplantation (LDLT) emerged in the 1980s as a viable alternative to scarce cadaveric organs for pediatric patients. However, pediatric waitlist mortality remains high. Long-term outcomes of living and deceased donor liver transplantation (DDLT) are inconsistently described in the literature. Our aim was to systematically review the safety and efficacy of LDLT after 1 year of transplantation among pediatric patients with all causes of liver failure. We searched the MEDLINE, Medline-in-Process, MEDLINE Epub Ahead of Print, Embase + Embase Classic (OvidSP), and Cochrane (Wiley) from February 1, 1947 to February 26, 2020, without language restrictions. The primary outcomes were patient and graft survival beyond 1 year following transplantation. A meta-analysis of unadjusted and adjusted odds and hazard ratios was performed using a random-effects model. A total of 24 studies with 3677 patients who underwent LDLT and 9098 patients who underwent DDLT were included for analysis. In patients with chronic or combined chronic liver failure and acute liver failure (ALF), 1-year (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.53-0.88), 3-year (OR, 0.73; 95% CI, 0.61-0.89), 5-year (OR, 0.71; 95% CI, 0.57-0.89), and 10-year (OR, 0.42; 95% CI, 0.18-1.00) patient and 1-year (OR, 0.50; 95% CI, 0.35-0.70), 3-year (OR, 0.55; 95% CI, 0.37-0.83), 5-year (OR, 0.5; 95% CI, 0.32-0.76), and 10-year (OR, 0.26; 95% CI, 0.14-0.49) graft survival were consistently better in LDLT recipients compared with those in DDLT recipients. In patients with ALF, no difference was seen between the 2 groups except for 5-year patient survival (OR, 0.60; 95% CI, 0.38-0.95), which favored LDLT. Sensitivity analysis by era showed improved survival in the most recent cohort of patients, consistent with the well-described learning curve for the LDLT technique. LDLT provides superior patient and graft survival outcomes relative to DDLT in pediatric patients with chronic liver failure and ALF. More resources may be needed to develop infrastructures and health care systems to support living liver donation.

中文翻译：

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儿科生活与已故供肝移植受者的长期结果：系统评价和荟萃分析

活体肝移植 (LDLT) 出现在 1980 年代，作为儿科患者稀缺尸体器官的可行替代方案。然而，儿科候补名单死亡率仍然很高。文献中对活体和已故供体肝移植 (DDLT) 的长期结果的描述不一致。我们的目的是系统评价所有原因肝衰竭的儿科患者移植 1 年后 LDLT 的安全性和有效性。我们检索了 1947 年 2 月 1 日至 2020 年 2 月 26 日期间的 MEDLINE、Medline-in-Process、MEDLINE Epub Ahead of Print、Embase + Embase Classic (OvidSP) 和 Cochrane (Wiley)，没有语言限制。主要结果是移植后超过 1 年的患者和移植物存活率。使用随机效应模型对未调整和调整后的优势和风险比进行荟萃分析。共纳入 24 项研究，其中 3677 名接受 LDLT 的患者和 9098 名接受 DDLT 的患者被纳入分析。在慢性或合并慢性肝功能衰竭和急性肝功能衰竭 (ALF) 的患者中，1 年（优势比 [OR]，0.68；95% 置信区间 [CI]，0.53-0.88），3 年（OR，0.73； 95% CI, 0.61-0.89)、5 年 (OR, 0.71; 95% CI, 0.57-0.89) 和 10 年 (OR, 0.42; 95% CI, 0.18-1.00) 患者和 1 年 (OR , 0.50; 95% CI, 0.35-0.70), 3 年 (OR, 0.55; 95% CI, 0.37-0.83), 5 年 (OR, 0.5; 95% CI, 0.32-0.76) 和 10 年(OR, 0.26; 95% CI, 0.14-0.49) 与 DDLT 受者相比，LDLT 受者的移植物存活率始终更高。在 ALF 患者中，除了有利于 LDLT 的 5 年患者生存率（OR，0.60；95% CI，0.38-0.95）外，两组之间没有发现差异。不同时代的敏感性分析显示，最近一组患者的生存率有所提高，这与 LDLT 技术的良好学习曲线一致。在患有慢性肝功能衰竭和 ALF 的儿科患者中，与 DDLT 相比，LDLT 提供了更好的患者和移植物存活结果。可能需要更多资源来发展基础设施和医疗保健系统，以支持活体肝脏捐赠。在患有慢性肝功能衰竭和 ALF 的儿科患者中，与 DDLT 相比，LDLT 提供了更好的患者和移植物存活结果。可能需要更多资源来发展基础设施和医疗保健系统，以支持活体肝脏捐赠。在患有慢性肝功能衰竭和 ALF 的儿科患者中，与 DDLT 相比，LDLT 提供了更好的患者和移植物存活结果。可能需要更多资源来发展基础设施和医疗保健系统，以支持活体肝脏捐赠。