Racial differences in liver transplantation outcomes in the MELD era
Racial differences in liver transplantation outcomes in the MELD era
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DOI：
10.1111/j.1572-0241.2008.01809.x
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发表时间：
2008-04-01
影响因子：
9.8
通讯作者：
Saeian, Kia
中科院分区：
文献类型：
--
作者：
Ananthakrishnan, Ashwin N.;Saeian, Kia
目的：从 2002 年 2 月 28 日开始，引入了终末期肝病模型 (MELD) 评分，以更好地分配供体肝脏。在此之前原位肝移植（OLT）结果的种族差异归因于某些种族群体的较晚列出。 MELD 时代移植后存活率的种族差异以前从未被研究过。 方法：我们使用器官共享联合网络数据库对 2002 年至 2006 年间进行的成人肝移植进行了一项回顾性观察队列研究。我们检查了患者和移植物的 2 年存活率，并比较了不同种族之间的疾病特异性存活率。结果：总共有 10,409 名白人， 该研究包括 1,133 名黑人、1,548 名西班牙裔和 765 名其他种族的移植接受者。多变量分析显示，与白人相比，黑人的 2 年总体生存率（死亡风险比 [HR] 1.29，95% 置信区间 [95% CI] 1.10-1.52）和移植物生存率（HR 1.38，95% CI 1.20-1.58）较低，而西班牙裔人的总体生存率（HR 0.78）和移植物生存率（HR 0.82）更好。与白人相比，因丙型肝炎或肝癌而接受移植的黑人 2 年生存率较低。结论：在 MELD 时代，黑人患者的 2 年总体生存率和移植物生存率显着低于白人。
OBJECTIVES: Beginning February 28, 2002, the Model for End-Stage Liver Disease (MELD) score was introduced to better allocate donor livers. Racial differences in orthotopic liver transplantation (OLT) outcomes prior to this time have been attributed to late listing of some racial groups. Racial differences in post-transplant survival in the MELD era have not been previously examined.METHODS: We performed a retrospective observational cohort study using the United Network for Organ Sharing database for adult liver transplants performed between 2002 and 2006. We examined patient and graft survival at 2 yr and compared disease-specific survival rates among the different races.RESULTS: A total of 10,409 whites, 1,133 blacks, 1,548 Hispanics, and 765 transplant recipients belonging to other races were included in the study. On multivariate analysis, blacks had lower overall (hazard ratio for death [HR] 1.29, 95% confidence interval [95% CI] 1.10-1.52) and graft (HR 1.38, 95% CI 1.20-1.58) survival at 2 yr compared to whites, while Hispanics had better overall (HR 0.78) and graft (HR 0.82) survival. Compared to whites, blacks transplanted for hepatitis C or HCC had lower survival at 2 yr.CONCLUSION: In the MELD era, black patients have significantly lower overall and graft survival at 2 yr compared to whites.