Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement
Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement
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DOI：
10.1097/tp.0000000000002249
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发表时间：
2019-03-01
期刊：
影响因子：
6.2
通讯作者：
Roberts, John P.
中科院分区：
文献类型：
--
作者：
Perito, Emily R.;Roll, Garrett;Roberts, John P.
背景。在美国，1 / 10的婴儿和1 / 20的大一点的儿童在等待肝脏移植的过程中死亡。增加分离肝移植可以增加这些儿童的器官可用性，而不会减少成人的移植。方法。使用联合器官共享标准移植分析和研究网络数据，我们根据严格的标准确定了2010年至2015年移植的可能用于分裂移植的肝脏。不适合儿科患者或分配给高危受体的肝脏被排除在外。将每个地区潜在“可分裂”肝脏的数量和分布与儿科等候名单上的死亡人数进行比较。结果。在37 333例移植的死亡供肝中，有6.3%符合我们严格的标准用于裂肝移植。其中只有3.8%用于裂肝移植。96%用于单个成年接受者。在2253例全肝移植中，82%的接受者被列为愿意接受节段性肝脏，只有3%的接受者被列为需要冷缺血时间少于6小时。在同样的5年里，有299名儿童在等待名单上死亡。在每个器官共享联合网络地区，潜在的“可分裂”肝脏比儿科等候名单上的死亡人数还要多。在研究期间，37%的儿童等待死亡发生在每年平均1例或更少的儿童肝移植中心。结论。这个比较，虽然不是结论性的，但表明我们可能错过了在不减少成人使用分离肝移植的机会的情况下减少儿科等待名单死亡率的机会。障碍是显著的，但进一步研究增加分裂肝移植的策略是有必要的。
Background. In the United States, 1 in 10 infants and 1 in 20 older children die on the liver transplant waiting list. Increasing split liver transplantation could increase organ availability for these children, without decreasing transplants in adults. Methods. Using United Network for Organ Sharing Standard Transplant Analysis and Research data, we identified livers transplanted 2010 to 2015 that could potentially have been used for split transplant, based on strict criteria. Livers not suitable for pediatric patients or allocated to high-risk recipients were excluded. Number and distribution of potentially "split-able" livers were compared to pediatric waitlist deaths in each region. Results. Of 37 333 deceased donor livers transplanted, 6.3% met our strict criteria for utilization in split liver transplant. Only 3.8% of these were actually utilized for split liver transplantation. 96% were used for a single adult recipient. Of the 2253 transplanted as whole livers, 82% of their recipients were listed as willing to accept a segmental liver, and only 3% were listed as requiring a cold ischemia time less than 6 hours. Over the same 5 years, 299 children died on the waitlist. In every United Network for Organ Sharing region, there were more potentially "split-able" livers than pediatric waitlist deaths. Thirty-seven percent of pediatric waitlist deaths occurred at transplant centers that averaged 1 or less pediatric split liver transplantation annually during the study period. Conclusions. This comparison, although not conclusive, suggests that we might be missing opportunities to reduce pediatric waitlist mortality without decreasing access for adults-using split liver transplant. Barriers are significant, but further work on strategies to increase split liver transplant is warranted.