Liver transplantation for hepatocellular carcinoma: The MELD impact
Liver transplantation for hepatocellular carcinoma: The MELD impact
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DOI：
10.1002/lt.20012
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发表时间：
2004-01-01
影响因子：
4.6
通讯作者：
Wiesner, RH
中科院分区：
文献类型：
--
作者：
Sharma, P;Balan, V;Wiesner, RH
基于终末期肝病(MELD)模型的联合器官共享网络(UNOS)的新分配策略为T1期或T2期肝细胞癌(HCC)患者提供了超出其肝脏失代偿程度的优先MELD评分。这项研究的目的是确定新的分配政策在MELD制度建立前后对肝细胞癌候选人的影响。对联合国操作系统数据库进行了审查，以确定1999年7月至2002年7月期间列出的所有肝癌候选对象。根据2002年2月27日新分配政策的实施日期，候选人按两个时间段分组。在2002年2月27日之前，已故供者肝移植(DDLT)的候选对象是在MELD前，而在2002年2月27日之后，这些候选对象是在MELD之后。通过比较DDLT的发生率、DDLT的时间、因临床恶化或死亡而退出等待名单的比率、等待期间和DDLT后的存活率进行比较。合并前和合并后计算的发病率以人年为单位。在研究期间，在UNOS数据库中列出了2,074个用于DDLT的肝癌候选对象。移植前DDLT发生率为0.439/人年，移植后为1.454人年(P<；0.001)。治疗前为2.28年，治疗后为0.69年(P<；0.001)。术后5个月的脱落率分别为16.5%和8.5%(P<；0.001)。术后5个月等待存活率分别为90.3%和95.7%(P<；0.001)。DDLT后5个月的存活率在两个时间段内相似。新的分配政策导致了肝癌患者DDLT的发生率增加。此外，5个月的辍学率显著下降。此外，在融合后时期，等待期间的5个月存活率有所增加。因此，新的基于MELD的分配政策使肝细胞癌候选人受益。
The new allocation policy of the United Network of Organ Sharing (UNOS) based on the model for end-stage liver disease (MELD) gives candidates with stage T1 or stage T2 hepatocellular carcinoma (HCC) a priority MELD score beyond their degree of hepatic decompensation. The aim of this study was to determine the impact of the new allocation policy on HCC candidates before and after the institution of MELD. The UNOS database was reviewed for all HCC candidates listed between July 1999 and July 2002. The candidates were grouped by two time periods, based on the date of implementation of new allocation policy of February 27,2002. Pre-MELD candidates were listed for deceased donor liver transplantation (DDLT) before February 27,2002, and post-MELD candidates were listed after February 27, 2002. Candidates were compared by incidence of DDLT, time to DDLT, and dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting and after DDLT. Incidence rates calculated for pre-MELD and post-MELD periods were expressed in person years. During the study, 2,074 HCC candidates were listed for DDLT in the UNOS database. The DDLT incidence rate was 0.439 transplant/person years pre-MELD and 1.454 transplant/person years post-MELD (P < 0.001). The time to DDLT was 2.28 years pre-MELD and 0.69 years post-MELD (P < 0.001). The 5-month dropout rate was 16.5% pre-MELD and 8.5% post-MELD (P < 0.001). The 5-month waiting-list survival was 90.3% pre-MELD and 95.7% post-MELD (P < 0.001). The 5-month survival after DDLT was similar for both time periods. The new allocation policy has led to an increased incidence rate of DDLT in HCC candidates. Furthermore, the 5-month dropout rate has decreased significantly. In addition, 5-month survival while waiting has increased in the post-MELD period. Thus, the new MELD-based allocation policy has benefited HCC candidates.