Deaths on the liver transplant waiting list: An analysis of competing risks
Deaths on the liver transplant waiting list: An analysis of competing risks
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DOI：
10.1002/hep.21025
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发表时间：
2006-02-01
期刊：
影响因子：
13.5
通讯作者：
Dickson, ER
中科院分区：
文献类型：
--
作者：
Kim, WR;Therneau, TM;Dickson, ER
估计生存概率的常用方法，即Kaplan-Meier方法，在分析移植等待名单上的死亡时是次优的。死亡、移植和退出名单都必须考虑在内。在这项分析中，我们应用了竞争风险分析方法，该方法允许单独和同时评估这些终点，以比较不同时代，血型，肝病诊断和严重程度的等待名单死亡的风险（终末期肝病模型; MELD）。1990年至1999年期间，在马约诊所罗切斯特的等待名单上登记的861名患者中，657名（76%）患者接受了移植，82名（10%）患者在等待期间死亡，41名（5%）患者退出名单，81名（9%）患者截至2002年2月仍在等待。通过竞争风险分析，3年时的死亡风险为10%。在研究期间，移植的中位时间从45天增加到517天。在单变量分析中，死亡风险与登记年龄（P = 0.25）或血型（P = 0.31）无显著差异，而酒精性肝病患者和MELD评分较高的患者死亡风险显著较高（P <0.01）。多变量分析显示，在调整MELD、血型和诊断后，后一时代的患者死亡率较高。总之，竞争风险分析方法在估计等待肝移植患者的死亡风险方面是有用的。
The usual method of estimating survival probabilities, namely the Kaplan-Meier method, is suboptimal in the analysis of deaths on the transplant waiting list. Death, transplantation, and withdrawal from list must all be considered. In this analysis, we applied the competing risk analysis method, which allows evaluating these end points individually and simultaneously, to compare the risk of waiting list death across era, blood types, liver disease diagnosis, and severity (Model for End-stage Liver Disease; MELD). Of 861 patients registered on the waiting list at Mayo Clinic Rochester between 1990 and 1999, 657 (76%) patients underwent transplantation, 82 (10%) died while waiting, 41 (5%) withdrew from the list, and 81 (9%) patients were still waiting as of February 2002. The risk of death at 3 years was 10% by the competing risk analysis. During the study period, the median time to transplantation increased from 45 to 517 days. In univariate analyses, there was no significant difference in the risk of death by era of listing (P = .25) or blood type (P = .31), whereas the risk of death was significantly higher in patients with alcohol-induced liver disease and those with higher MELD score (P < .01). A multivariable analysis showed that after adjusting for MELD, blood type, and diagnosis, patients listed in the latter era had higher mortality. In conclusion, the competing risk analysis method is useful in estimating the risk of death among patients awaiting liver transplantation.