Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast?
Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast?
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DOI：
10.1002/lt.25409
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发表时间：
2019-05-01
影响因子：
4.6
通讯作者：
Hashimoto, Koji
中科院分区：
文献类型：
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作者：
Sasaki, Kazunari;Firl, Daniel J.;Hashimoto, Koji
最近一项使用美国国家登记数据的研究报告，使用考克斯比例风险（PH）模型，劈离式肝移植（CLP）随着时间的推移而改善，并不比全肝移植（WLT）更危险。然而，研究方法违反了PH假设，这是考克斯模型的基本假设。因此，报告的风险比（HR）存在偏倚且不可靠。这项研究旨在调查移植物存活（GS）的风险是否真的随着时间的推移而改善，确保对PH假设的关注。这项研究包括80，998例来自科学登记移植中心的成人死亡供体肝移植（LT）（1998-2015）。研究阶段分为3个时间段：第1阶段（1998年1月至2002年2月）、第2阶段（2002年3月至2008年12月）和第3阶段（2009年1月至2015年12月）。使用Schoenfeld检验检验PH假设，并且在HR ≥ 100的情况下，评估移植后随时间推移的PH风险变化。在1098例（1.4%）患者中进行了手术，而在79，900例患者中使用了WLT。在考克斯PH分析中，Schoenfeld总体检验的P值为
A recent study using US national registry data reported, using Cox proportional hazards (PH) models, that split-liver transplantation (SLT) has improved over time and is no more hazardous than whole-liver transplantation (WLT). However, the study methods violated the PH assumption, which is the fundamental assumption of Cox modeling. As a result, the reported hazard ratios (HRs) are biased and unreliable. This study aimed to investigate whether the risk of graft survival (GS) in SLT has really improved over time, ensuring attention to the PH assumption. This study included 80,998 adult deceased donor liver transplantation (LT) (1998-2015) from the Scientific Registry Transplant Recipient. The study period was divided into 3 time periods: era 1 (January 1998 to February 2002), era 2 (March 2002 to December 2008), and era 3 (January 2009 to December 2015). The PH assumption was tested using Schoenfeld's test, and where the HR of SLT violated the assumption, changes in risk for SLT over time from transplant were assessed. SLT was performed in 1098 (1.4%) patients, whereas WLT was used in 79,900 patients. In the Cox PH analysis, the P values of Schoenfeld's global tests were