Survival Benefit-Based Deceased-Donor Liver Allocation
Survival Benefit-Based Deceased-Donor Liver Allocation
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DOI：
10.1111/j.1600-6143.2009.02571.x
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发表时间：
2009-01-01
影响因子：
8.8
通讯作者：
Merion, R. M.
中科院分区：
文献类型：
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作者：
Schaubel, D. E.;Guidinger, M. K.;Merion, R. M.
目前，等待死亡供体肝移植的患者按医疗紧急程度优先考虑。具体地，将等待名单上的慢性肝衰竭患者以终末期肝病模型（MELD）评分的降序进行排序。为了最大限度地延长通过肝脏移植获得的寿命，在优先考虑肝脏等待名单候选人时应考虑移植后生存率。我们评估了一个基于生存效益的系统，用于将死亡供体肝脏分配给慢性肝功能衰竭患者。根据拟议的制度，在提供移植时，将为等待名单上的每一名活跃患者计算移植存活益处评分。建议的评分是基于5年平均寿命的差异（有肝移植与无肝移植），并考虑了患者和供体的特征。获益评分与MELD评分之间的等级相关为0.67。有很大的重叠分布的福利评分在MELD类别，因为等候名单死亡率显着影响到几个因素。模拟结果表明，如果实施基于效益的分配，每年将节省2000多个生命年。供体肝脏的短缺增加了最大限度地提高所获得肝脏的救生能力的需要。将死亡供体肝脏分配给慢性肝功能衰竭患者将通过根据移植生存获益对患者进行优先排序来改善。
Currently, patients awaiting deceased-donor liver transplantation are prioritized by medical urgency. Specifically, wait-listed chronic liver failure patients are sequenced in decreasing order of Model for End-stage Liver Disease (MELD) score. To maximize lifetime gained through liver transplantation, posttransplant survival should be considered in prioritizing liver waiting list candidates. We evaluate a survival benefit based system for allocating deceased-donor livers to chronic liver failure patients. Under the proposed system, at the time of offer, the transplant survival benefit score would be computed for each patient active on the waiting list. The proposed score is based on the difference in 5-year mean lifetime (with vs. without a liver transplant) and accounts for patient and donor characteristics. The rank correlation between benefit score and MELD score is 0.67. There is great overlap in the distribution of benefit scores across MELD categories, since waiting list mortality is significantly affected by several factors. Simulation results indicate that over 2000 life-years would be saved per year if benefit-based allocation was implemented. The shortage of donor livers increases the need to maximize the life-saving capacity of procured livers. Allocation of deceased-donor livers to chronic liver failure patients would be improved by prioritizing patients by transplant survival benefit.