Efficacy of liver transplantation in patients with primary biliary cirrhosis.
Efficacy of liver transplantation in patients with primary biliary cirrhosis.
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DOI：
10.1056/nejm198906293202602
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发表时间：
1989-06
期刊：
影响因子：
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通讯作者：
B. Markus;E. Dickson;P. Grambsch;T. Fleming;V. Mazzaferro;G. Klintmalm;R. Wiesner;D. V. Van Thiel;T. Starzl
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文献类型：
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作者：
B. Markus;E. Dickson;P. Grambsch;T. Fleming;V. Mazzaferro;G. Klintmalm;R. Wiesner;D. V. Van Thiel;T. Starzl
尚未进行对照试验来评估肝移植的疗效。由于自 1981 年以来肝移植后生存率显着改善，将患者随机分配到未接受移植的对照组在临床上被认为是不合适的。为了评估肝移植对原发性胆汁性肝硬化患者的疗效，我们将 161 名接受肝移植的具有该诊断的患者的生存率与具有相同诊断且接受保守治疗的患者的生存率进行了比较。该比较是使用最近开发的统计技术——梅奥模型进行的。所有患者均于1980年3月至1987年6月期间接受了肝移植，并随访中位25个月。肝移植后三个月，受者的 Kaplan-Meier 生存概率显着高于 Mayo 模型“模拟对照”生存概率（P 小于 0.001）。两年时，Kaplan-Meier 生存概率为 0.74，而 Mayo 模型平均生存概率为 0.31。根据Mayo模型，处于低风险的患者肝移植后存活的概率最高；然而，处于所有风险水平的接受过肝移植的患者的生存概率高于未接受过肝移植的患者。我们的结论是，肝移植是晚期原发性胆汁性肝硬化患者的有效治疗方法。
No controlled trials have been performed to assess the efficacy of liver transplantation. Because of the marked improvement in survival after liver transplantation since 1981, random assignment of patients to a control group not undergoing transplantation is considered clinically inappropriate. To assess the efficacy of liver transplantation in patients with primary biliary cirrhosis, we compared survival in 161 patients with this diagnosis who had undergone a liver transplantation with survival in patients with the same diagnosis who had been treated conservatively. The comparison was performed with use of a recently developed statistical technique, the Mayo model. All patients had undergone liver transplantation between March 1980 and June 1987 and were followed for a median of 25 months. Three months after liver transplantation, the Kaplan-Meier survival probabilities in the recipients were substantially higher than the Mayo-model "simulated-control" survival probabilities (P less than 0.001). At two years, the Kaplan-Meier survival probability was 0.74, whereas the mean Mayo-model survival probability was 0.31. The patients who were at low risk according to the Mayo model had the best probability of survival after liver transplantation; however, patients at all risk levels who had undergone liver transplantation had higher probabilities of survival that those who had not. We conclude that liver transplantation is an efficacious treatment in patients with advanced primary biliary cirrhosis.