Normalised intrinsic mortality risk in liver transplantation: European Liver Transplant Registry study
Normalised intrinsic mortality risk in liver transplantation: European Liver Transplant Registry study
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DOI：
10.1016/s0140-6736(00)02603-9
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发表时间：
2000-08-19
期刊：
影响因子：
168.9
通讯作者：
Bismuth, H
中科院分区：
文献类型：
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作者：
Adam, R;Cailliez, V;Bismuth, H
背景目前还没有肝移植模型来评估特定患者的死亡风险，也没有标准来评估不同中心的表现。我们调查了内在的死亡风险的情况下，已知的死亡风险因素，方法我们确定了死亡风险因素和风险比量化的数据从欧洲肝移植登记处（22 089例患者在102个中心在18个国家）从1988年至1997年注册。为了建立一个内在风险模型和特定因素的风险比，对总人群、成人和15岁以下儿童分别进行了单变量和多变量分析，并估计了死亡人数，我们通过比较无危险因素患者的死亡率与有危险因素患者的模型校正死亡率来验证该模型。年生存率分别为66%（95%CI 65-66）和61%（60-62）。65%的死亡发生在6个月内，再次移植、癌症移植、急性肝功能衰竭、每年少于20例劈离式肝移植和每年少于25例移植的中心工作量是12个确定因素中的主要风险因素，无危险因素的成人1年和5年死亡率与模型估计值相似（15 [13-16] vs 14% [13-15]，22（20-24）vs 23% [21-24]）。儿科移植的相应数据为9%（7-12）与11%（9-12）和13%（10-17）与14%（11-16）。在高容量中心，无危险因素的患者死亡风险降低更大（48% vs 23%，p
Background No model exists for liver transplantation to estimate the mortality risk in a given patient, and no standard by which to assess performance in different centres. We investigated the intrinsic mortality risk in the absence of known mortality risk factors,Methods We identified mortality risk factors and risk ratios quantified in data from the European Liver Transplant Registry (22 089 patients at 102 centres in 18 countries) registered from 1988 to 1997. To develop a model of the intrinsic risk and the risk ratios for specific factors, univariate and multivariate analyses were done separately for the overall population, for adults, and for children younger than 15 years, and the number of deaths were estimated, We validated the model by comparing mortality in patients without risk factors with the model-adjusted mortality in patients with risk factors.Findings Overall 5-year and 8-year actuarial survival was 66% (95% CI 65-66) and 61% (60-62). 65% of deaths occurred within 6 months, Retransplantation, transplantation for cancer, acute liver failure, fewer than 20 split-liver grafts per year, and a centre workload of fewer than 25 transplants per year were the main risk factors of 12 identified factors, 1-year and 5-year death rates among adults with no risk factors were similar to model estimates (15 [13-16] vs 14% [13-15], and 22 (20-24) vs 23% [21-24]). Corresponding data for paediatric transplants were 9% (7-12) compared with 11% (9-12) and 13% (10-17) compared with 14% (11-16). The reduction of mortality risk in high-volume centres was even greater in patients without risk factors (48 vs 23%, p