Impact of Donor Liver Macrovesicular Steatosis on Deceased Donor Yield and Posttransplant Outcome.
Impact of Donor Liver Macrovesicular Steatosis on Deceased Donor Yield and Posttransplant Outcome.
复制标题
供体肝脏大泡脂肪变性对已故供体产量和移植后结果的影响。
DOI：
10.1097/tp.0000000000004291
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发表时间：
2023
期刊：
影响因子：
6.2
通讯作者：
Israni,AjayK
中科院分区：
文献类型：
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作者：
Kwong,AllisonJ;Kim,WRay;Lake,John;Stock,PeterG;Wang,ConnieJ;Wetmore,JamesB;Melcher,MarcL;Wey,Andrew;Salkowski,Nicholas;Snyder,JonJ;Israni,AjayK
背景。移植受者科学登记（SRTR）传统上并未在风险调整模型中考虑活检结果，但活检结果可能会影响结果，从而影响器官接受的决定。方法：使用SRTR数据，包括美国所有供者、候选者和移植受者的数据，我们评估了：(1)大泡性脂肪变性对死亡供体移植率（定义为每个供体移植的肝脏数量）和移植后1年移植失败的影响；(2)将这一变量纳入现有SRTR风险调整模型的影响。结果：纳入了21 559例有任何恢复器官的供体和17 801例肝移植受者。供体肝活检中大泡性脂肪变性水平的增加预示着较低的器官产量：肝活检中大泡性脂肪变性≥31%与87% - 95%的低利用率相关，55%的肝脏被丢弃。与没有移植前肝活检和0% - 10%脂肪变性的患者相比，这些肝脏移植失败的风险比为1.53。当风险调整模型中加入大泡性脂肪变性时，器官获取组织特异性死亡供体产量或移植后项目特异性结果评估的变化很小。结论：相对于移植失败的风险，患有大泡性脂肪变性的供体肝脏不移植的比例不成比例。为了避免过度的风险规避，SRTR现在在SRTR风险调整模型中考虑了大泡性脂肪变性，以帮助促进这些高风险器官的使用。增加对这一变量的认识也可能鼓励进一步努力使肝活检结果的报告标准化。
Background.The Scientific Registry of Transplant Recipients (SRTR) had not traditionally considered biopsy results in risk-adjustment models, yet biopsy results may influence outcomes and thus decisions regarding organ acceptance.Methods.Using SRTR data, which includes data on all donors, waitlisted candidates, and transplant recipients in the United States, we assessed (1) the impact of macrovesicular steatosis on deceased donor yield (defined as number of livers transplanted per donor) and 1-y posttransplant graft failure and (2) the effect of incorporating this variable into existing SRTR risk-adjustment models.Results.There were 21 559 donors with any recovered organ and 17 801 liver transplant recipients included for analysis. Increasing levels of macrovesicular steatosis on donor liver biopsy predicted lower organ yield:≥ 31% macrovesicular steatosis on liver biopsy was associated with 87% to 95% lower odds of utilization, with 55% of these livers being discarded. The hazard ratio for graft failure with these livers was 1.53, compared with those with no pretransplant liver biopsy and 0% to 10% steatosis. There was minimal change on organ procurement organization–specific deceased donor yield or program-specific posttransplant outcome assessments when macrovesicular steatosis was added to the risk-adjustment models.Conclusions.Donor livers with macrovesicular steatosis are disproportionately not transplanted relative to their risk for graft failure. To avoid undue risk aversion, SRTR now accounts for macrovesicular steatosis in the SRTR risk-adjustment models to help facilitate use of these higher-risk organs. Increased recognition of this variable may also encourage further efforts to standardize the reporting of liver biopsy results.