OPTN policy regarding prioritization of patients with hepatopulmonary syndrome:: Does it provide equitable organ allocation?
OPTN policy regarding prioritization of patients with hepatopulmonary syndrome:: Does it provide equitable organ allocation?
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DOI：
10.1111/j.1600-6143.2007.02124.x
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发表时间：
2008-05-01
影响因子：
8.8
通讯作者：
Voigt, M. D.
中科院分区：
文献类型：
--
作者：
Sulieman, B. M.;Hunsicker, L. G.;Voigt, M. D.
器官移植联合网络（UNOS）政策3.6.4.5.1为诊断为肝肺综合征（HPS）的患者提供例外点，以补偿他们报告的死亡风险增加。我们比较了255名在该政策下接受例外点的患者（HPS政策患者）和32358名在终末期肝病（MELD）时代模型中列出的非例外对照患者的移植前后和总体结果，以确定是否符合该政策的意图。总体而言，92.5%的HPS政策患者和45.5%的对照组进行了移植，5.1%和31.2%仍在等待名单上，1.5%和14.1%在等待移植期间死亡（每个比较的p < 0.0001）。与对照组相比，HPS政策患者移植前的相对死亡风险（RR）为0.158（置信区间[CI]: 0.059 ~ 0.420, p = 0.0002），移植后的相对死亡风险（RR）为0.827（置信区间[CI]: 0.587 ~ 1.170, p = 0.28）。与对照组相比，总体（合并等待名单和移植后）死亡的RR为0.514 （CI: 0.374-0.707, p = 0.00004）。调整实验室MELD后，总RR为0.807 (CI: 0.587-1.110, p = 0.19)，说明如果纳入HPS政策患者的实验室MELD评分，其死亡风险与对照组相似。HPS政策患者相比标准肝移植候选人有明显的移植前生存优势，因为获得了例外积分，并且移植后生存相似。需要更好的HPS诊断和分级标准。
United Network for Organ Transplantation (UNOS) policy 3.6.4.5.1 provides exception points to patients diagnosed with hepatopulmonary syndrome (HPS) to compensate for their reported increased mortality risk. We compared pre- and posttransplant and overall outcomes in 255 patients receiving exception points under this policy (HPS policy patients) with 32 358 nonexception control patients listed in the model for end-stage liver disease (MELD) era to determine whether the intent of the policy is being met.Overall, 92.5% of HPS policy patients versus 45.5% of controls had been transplanted, 5.1% versus 31.2% remained on waiting list and 1.5% versus 14.1% had died while awaiting transplant (p < 0.0001 for each comparison). Relative risk (RR) of death for HPS policy patients compared to controls was 0.158 (confidence interval [CI]: 0.059-0.420, p = 0.0002) pretransplant, and 0.827 (CI: 0.587-1.170, p = 0.28) posttransplant. Overall (combined waitlist and posttransplant) RR of death was 0.514 (CI: 0.374-0.707, p = 0.00004) compared with controls. After adjustment for laboratory MELD, overall RR was 0.807 (CI: 0.587-1.110, p = 0.19), indicating that HPS policy patients' mortality risk would be similar to that of controls had they been listed with their laboratory MELD score.HPS policy patients have a significant pretransplant survival advantage over standard liver transplant candidates because of the exception points awarded, and have similar posttransplant survival. Better criteria for diagnosing and grading of HPS are required.