The new liver allocation system: Moving toward evidence-based transplantation policy
The new liver allocation system: Moving toward evidence-based transplantation policy
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DOI：
10.1053/jlts.2002.35927
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发表时间：
2002-09-01
影响因子：
4.6
通讯作者：
Teperman, L
中科院分区：
文献类型：
--
作者：
Freeman, RB;Wiesner, RH;Teperman, L
1999年，医学研究所建议，建立一个连续的疾病严重程度评分，不强调等待时间，可以改善尸体肝脏移植的分配。本报告介绍了这一新计划的制定和初步实施情况。其目标是开发一种连续的疾病严重程度量表，使用客观、现成的变量来预测终末期肝脏疾病患者的死亡风险，并减少对等待时间的重视。还制定了一些机制，以纳入没有高死亡风险但移植可能紧迫的良好移植候选人。终末期肝病模型（MELD）和儿科终末期肝病（PELD）评分被选为新分配政策的基础，因为它们在预测具有各种肝病病因和广泛肝病严重程度的患者死亡方面具有高度准确性。除最紧急的患者外，所有患者将根据其MELD/PELD评分在新政策下连续排名。等待时间仅用于优先考虑MELD/PELD评分相同的患者。MELD/PELD评分未得到良好服务的患者可通过区域化同行评审系统进行优先排序。这种新的肝脏分配计划是基于更客观，可验证的疾病严重程度的措施，最小限度地强调等待时间。应用这种风险模型提供了一种循证方法，可在此基础上进一步完善和改进模型。
In 1999, the Institute of Medicine suggested that instituting a continuous disease severity score that de-emphasizes waiting time could improve the allocation of cadaveric livers for transplantation. This report describes the development and initial implementation of this new plan. The goal was to develop a continuous disease severity scale that uses objective, readily available variables to predict mortality risk in patients with end-stage liver disease and reduce the emphasis on waiting time. Mechanisms were also developed for inclusion of good transplant candidates who do not have high risk of death but for whom transplantation may be urgent. The Model for End-Stage Liver Disease (MELD) and Pediatric End-Stage Liver Disease (PELD) scores were selected as the basis for the new allocation policy because of their high degree of accuracy for predicting death in patients having a variety of liver disease etiologies and across a broad spectrum of liver disease severity. Except for the most urgent patients, all patients will be ranked continuously under the new policy by their MELD/PELD score. Waiting time is used only to prioritize patients with identical MELD/PELD scores. Patients who are not well served by the MELD/PELD scores can be prioritized through a regionalized peer review system. This new liver allocation plan is based on more objective, verifiable measures of disease severity with minimal emphasis on waiting time. Application of such risk models provides an evidenced-based approach on which to base further refinements and improve the model.