Survival After Liver Transplantation Using Hepatitis C Virus-Positive Donor Allografts: Case-Controlled Analysis of the UNOS Database
Survival After Liver Transplantation Using Hepatitis C Virus-Positive Donor Allografts: Case-Controlled Analysis of the UNOS Database
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DOI：
10.1007/s00268-011-1019-5
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发表时间：
2011-07-01
影响因子：
2.6
通讯作者：
Shah, Shimul A.
中科院分区：
文献类型：
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作者：
Burr, Andrew T.;Li, YouFu;Shah, Shimul A.
背景许多报道表明，在肝移植（奥尔特）中使用丙型肝炎（HCV）血清阳性同种异体移植物后，移植物和患者存活率降低。我们的目的是通过对器官共享联合网络（UNOS）数据库的病例对照分析，研究与HCV供体同种异体移植物相比，HCV+肝移植物的使用是否会影响患者和移植物的存活率。（61，905名献血者HCV-; 1，244名献血者HCV+），来自UNOS标准移植分析和研究（星星）文件，1987年至2007年。收集供体和受体的人口统计学资料和结局，其中供体HCV血清学检查完整。使用匹配算法的倾向评分创建了一个病例对照队列，该队列由11个供体和受体变量组成，比较供体HCV-和HCV+同种异体移植物（每组n = 540）。移植物和患者的生存率估计使用Kaplan-Meier生存current.Results显着差异是显而易见的，在未调整的队列之间接受HCV+和HCV-同种异体移植，包括HCV+受体，供体和受体的年龄，和模型的终末期肝病（MELD）例外情况。使用HCV+同种异体移植物导致奥尔特后移植物存活率（8.1 vs. 10.6年; P = 0.001）和患者存活率（10.2 vs. 12.3年; P = 0.01）显著降低。在匹配的队列中，HCV血清阳性对移植物（P = 0.57）或患者（P = 0.78）的生存率没有不利影响奥尔特.Conclusions这是第一个基于人群的分析表明，调整后的供体和受体的特点，有没有不同的移植物或患者的生存与HCV+供体肝移植相比，HCV供体肝移植。
Background Numerous reports have documented reduced graft and patient survival after use of hepatitis C (HCV) seropositive allografts in liver transplantation (OLT). We aimed to examine if the use of a HCV+ liver allograft affects patient and graft survivals compared to HCV-donor allografts in a case-controlled analysis of the united network for organ sharing (UNOS) database.Methods We examined 63,149 liver transplants (61,905 donors HCV-; 1,244 donors HCV+) from the UNOS standard transplant analysis and research (STAR) file from 1987 to 2007. Donor and recipient demographics and outcomes were collected in which donor HCV serology was complete. A case-controlled cohort from 11 donor and recipient variables comparing donor HCV- and HCV+ allografts (n = 540 in each group) was created using propensity scores with a matching algorithm. Graft and patient survival was estimated using Kaplan-Meier survival curves.Results Significant differences were evident in the unadjusted cohort between recipients who received HCV+ and HCV-allografts, including HCV+ recipients, donor and recipient age, and model for end-stage liver disease (MELD) exception cases. Use of HCV+ allograft resulted in significantly lower graft survival (8.1 vs. 10.6 years; P = 0.001) and patient survival (10.2 vs. 12.3 years; P = 0.01) after OLT. In the matched cohort, HCV seropositivity had no detrimental effect on the graft (P = 0.57) or patient (P = 0.78) survival after OLT.Conclusions This is the first population-based analysis to show that after adjusting for donor and recipient characteristics there was no difference in graft or patient survival with the use of HCV+ donor liver allografts compared to HCV-donor liver allografts.