Utilization and outcomes of rescue hepatectomy among U.S. liver retransplant candidates.
Utilization and outcomes of rescue hepatectomy among U.S. liver retransplant candidates.
复制标题
美国肝再移植候选人中挽救性肝切除术的利用和结果。
DOI：
10.1111/ctr.14890
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发表时间：
2023
影响因子：
2.1
通讯作者：
Bittermann,Therese
中科院分区：
文献类型：
--
作者：
Kathawate,RanganathG;Ibeabuchi,Tobenna;Abt,PeterL;Bittermann,Therese
前言在美国，无肝移植患者的频率和结果尚未被研究过。联合器官共享网络(UNOS)记录了因肝动脉血栓形成(HAT)或原发性无功能(PNF)而被列为状态1A的患者的无肝状态。方法利用UNOS数据库，对2005年至2020年因HAT或PNF而被重新列为状态1A的无肝候选患者的人口学特征和等待结果进行评估。结果在120个不同的移植中心中，1364名成人状态为1A的患者再次接受PNF或HAT，其中75例(5.5%)无肝患者，1289例(94.5%)非无肝患者。相当多的中心(n=51)有≥-1无肝患者再次接受PnF或HAT的经验，单个中心的比率从0%到11.4%不等。无肝患者的等待死亡率是无肝患者的两倍多：42.5%，而非无肝患者的等待死亡率为17.0%(p<；2.001)。无肝患者移植后的预后明显低于无肝患者。例如，41.9%的无肝病患者在指数入院期间死亡，而非无肝病组的死亡率为23.4%(p=0.006)。无肝组和无肝组的患者存活率分别为48.3%和66.2%(1年为66.2%)和29.3%(5年为46.2%)(总存活率的对数等级检验=10.014)。结论初次肝移植后的抢救性肝切除术不仅与较高的等待死亡率有关，而且移植后的预后也明显较差。由于不到一半的无肝患者存活到肝移植后的第一年，有必要进行进一步的研究，以更好地描述哪些患者应该考虑进行抢救性肝切除术。
IntroductionThe frequency and outcomes of anhepatic patients listed for transplantation in the United States have not been studied. The United Network for Organ Sharing (UNOS) records anhepatic status for patients listed as Status 1A for hepatic artery thrombosis (HAT) or primary non‐function (PNF).MethodsUsing the UNOS database from 2005 to 2020, demographics and waitlist outcomes of anhepatic candidates relisted as Status 1A for HAT or PNF were assessed.ResultsAmong 1364 adult Status 1A patients relisted for PNF or HAT across 120 distinct transplant centres, 75 (5.5%) patients were anhepatic and 1289 (94.5%) were non‐anhepatic. A substantial number of centres (n= 51) had experience with ≥1 anhepatic patient relisted for either PNF or HAT, with individual centre rates ranging from 0% to 11.4%. Waitlist mortality was more than twice as high for anhepatic patients: 42.5% versus 17.0% non‐anhepatic patients (p< .001). The post‐transplant outcomes of anhepatic patients were markedly inferior to non‐anhepatic patients. For example, 41.9% of anhepatic patients died during the index admission versus 23.4% of the non‐anhepatic group (p= .006). Patient survival for the anhepatic and non‐anhepatic groups was 48.3% versus 66.2% at 1‐year and 29.3% versus 46.2% at 5‐years, respectively (log‐rank test for overall survivalp= .014).ConclusionsRescue hepatectomy after initial liver transplantation is not only associated with high waitlist mortality, but also markedly worse post‐transplant outcomes. With less than half of anhepatic patients surviving to the first year post‐LT, further research is warranted to better delineate which patients should be considered for rescue hepatectomy.