Liise K. Kayler, Kusum Tom, Paolo Fontes, Igor Dvorchik, Amadeo Marcos.外科，匹兹堡大学医学中心，匹兹堡，宾夕法尼亚州，美国。

背景：肝脏移植是目前最昂贵的外科手术之一。在手术费用和疗效的问题上，与尸体肝移植(DDLT)相比，活体肝移植（LDLT）由于有机会选择病情较轻的患者和选择合适的时间进行手术而更加有利。但是，很少有研究涉及到该问题。

方法：分析在2001年1月至2004年12月期间连续进行的833例成人肝移植案例（74例活体肝移植，758例尸体肝移植）。在下列时期记录所用费用：（1）移植前，移植前90天；（2）住院治疗期；（3）移植后，住院治疗期后365天。以任意费用单位（ChU）来表示，从5000美金到15000美金不等。

结果：活体肝移植的平均费用比尸体肝移植在移植前看护期低三倍(p<0.0001)，移植住院期低22%(p=0.0316)，出院后医疗护理低8% (p=0.2113)。与尸体肝移植相比，基线特征表明活体肝移植组的健康状况更好，表现为终末期肝病模型的评分更低（p<0.0001），平均 90天的移植前住院时间更短(p=0.0091)，在等候肝移植名单上的平均等待时间更短( p<0.0001)，相应的术前机械通气需求更少（p=0.0320)等。

结论：活体肝移植与尸体肝移植相比，其巨大的成本优势取决于受体的健康状况。

Finacial Comparison of Adult-to-Adult Liver Transplantation from Living- VS Deceased-Donors
Liise K. Kayler, Kusum Tom, Paolo Fontes, Igor Dvorchik, Amadeo Marcos. Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Background: Liver transplantation is one of the most costly surgical procedures performed today. Live-donor liver transplantation (LDLT) may be more financially advantageous over deceased-donor liver transplantation (DDLT) due to the opportunity to select patients who are less ill and to operate in an elective manner; however, few studies have addressed this issue.

Methods: Between January 2001 and December 2004, 833 consecutive adult liver transplants (LDLT 74, DDLT 758) were analyzed. Charges were recorded for the following time periods: (1) pretransplant, 90 days before transplantation, (2) the transplant hospitalization, and (3) posttransplant , 365 days after the transplant hospitalization. Charges were expressed as an arbitrary charge unit (ChU) that is a value between $5,000 and $15,000.

Results: Compared with DDLT, the average ChU for LDLT was threefold lower for pretransplant care (p<0.0001), 22% lower for the transplant admission (p=0.0316), and 8% lower for post-hospitalization medical care (p=0.2113). Baseline characteristics indicated a healthier status of the LDLT group who exhibited significantly lower MELD scores ( p<0.0001), shorter average 90-day pretransplant hospital length of stays (p=0.0091), shorter average time on the liver transplant waiting list ( p<0.0001), and proportionately less requirement for pretransplant mechanical ventilation (p=0.0320], compared to DDLT recipients.

Conclusion: The magnitude of the cost advantage for living- over deceased- donor transplantation depends greatly on recipient health.

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