Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases.
Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases.
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DOI：
10.1097/00007890-199810150-00034
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发表时间：
1998-10-15
期刊：
影响因子：
6.2
通讯作者：
Wiesner, R H
中科院分区：
文献类型：
--
作者：
Lucey, M R;Brown, K A;Wiesner, R H
目前在美国，肝移植候选人的数量和可供移植的供体肝脏数量之间存在严重差异。没有什么比目前在器官共享联合网络（UNOS）等待肝移植的患者数量迅速增加更好地说明了这一点（1）。这种供体器官的相对短缺助长了最近关于供体器官分配和分配的争议。这场争论的主要问题之一是在该国不同地区接受肝移植之前，移植等待名单上的天数存在明显差异。对这些区域差异有许多可能的解释。这些解释包括，目前的捐赠器官识别、检索、分配和分配制度可能导致全国肝脏分配不均。这是一个有争议的领域，移植界内外的许多感兴趣的各方都持有相互矛盾的观点。此外，还有一种可能性，即该国不同地区的病人在其疾病自然史的不同阶段被列入等候名单。这种做法可能会导致病人获得肝移植的优先权，只不过是地理上的意外。此外，人们担心，由于某些地区的等待时间很长，移植计划面临着在患者实际需要移植之前尽早将其列入名单的压力，这种做法被称为“等待名单膨胀”。为了解决这些问题，器官共享联合网络（UNOS）最近要求各器官特定委员会制定进入国家等待名单的器官特定标准。1997年2月21日，肝移植界在美国国立卫生研究院（NIH）校园内的Natcher中心开会，制定最低上市标准。会议由美国移植医师协会（ASTP）和美国肝病研究协会（AASLD）共同主办。它也得到了联合国器官共享网络肝脏和肠道委员会的认可。UNOS肝脏和肠道委员会的一个小组委员会已经制定了肝脏特异性最低列名标准。这些标准被用作讨论的出发点，并在认为联合国系统事务处的标准限制性太强、限制性不够或需要修改时提出了修改建议。作为本次会议的组织者，我们认识到特定患者获得同种异体移植物的机会受到管理供体器官分配和分配的规则的影响，但本次会议的目标仅限于制定潜在肝移植受体的最低名单标准。本文总结了与会者对成人患者原位肝移植最低列名标准的看法。一篇配套论文讨论了儿科候选人的最低标准（2）。
There is a severe discrepancy between the number of liver transplant candidates and number of donor livers available for transplantation in the United States at the present time. Nothing illustrates this better than the rapid rise in the number of patients currently on the United Network for Organ Sharing (UNOS) waiting list for liver transplantation (1). This relative shortage of donor organs has fueled the recent controversy over the distribution and allocation of donor organs. One of the principal issues in this controversy is the marked difference in the number of days on the transplant waiting list before receiving a liver transplant in different parts of the country. There are many possible explanations for these regional differences. The explanations include the possibility that the present system of donor organ identification, retrieval, distribution and allocation results in unequal distribution of livers throughout the country. This is a contentious area, about which many interested parties, both inside and outside the transplant community, hold conflicting views. In addition, there is the possibility that patients in different parts of the country are placed on the waiting list at different points in the natural history of their diseases. This practice could result in a patient getting priority for liver transplantation based on nothing more than an accident of geography. Furthermore, there is the concern that, because of long waiting times in certain regions, there is a pressure on transplant programs to list patients early, before they actually require transplantation, a practice referred to as' waiting list inflation.'In order to address these concerns, United Network for Organ Sharing (UNOS) recently asked the various organ specific committees to develop organ specific criteria for entry into the national waiting list. On February 21, 1997, the liver transplant community met at the Natcher Center on the campus of the National Institutes of Health (NIH) to formulate minimal listing criteria. The meeting was cosponsored by the American Society of Transplant Physicians (ASTP) and the American Association for the Study of Liver Diseases (AASLD). It also was endorsed by the Liver and Intestinal Committee of UNOS. A subcommittee of the UNOS Liver and Intestinal Committee had already developed liver-specific minimal listing criteria. These were used as a starting point for discussion and changes were recommended where the UNOS criteria were felt to be too restrictive, not restrictive enough or in need of modification. While we, as organizers of this meeting, recognize that the access of particular patients to an allograft is influenced by rules governing the allocation and distribution of donor organs, the objectives of this conference were confined to the development of minimal listing criteria for potential liver transplant recipients. The present paper summarizes the views of the participants regarding minimal listing criteria for orthotopic liver transplantation for adult patients. A companion paper discusses minimal criteria for pediatric candidates (2).