National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States
National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States
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DOI：
10.1001/jamainternmed.2018.6536
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发表时间：
2019-03-01
影响因子：
39
通讯作者：
Terrault, Norah A.
中科院分区：
文献类型：
--
作者：
Lee, Brian P.;Vittinghoff, Eric;Terrault, Norah A.
重要性酒精性肝病(ALD)已经成为美国最常见的肝移植适应症，但关于这种增加的原因以及肝移植受者肝移植后长期结果的数据很少。目的描述2002至2016年间美国ALD肝移植的趋势和长期结果。设计、设置和参与者这项多中心、前瞻性、全国性的队列研究使用了来自美国器官共享联合网络数据库的数据来评估2002年1月1日至2016年12月31日期间在美国进行的所有肝移植。通过对丙型肝炎病毒感染和肝细胞癌的敏感性分析，包括早期(肝移植后90天)患者和移植物存活。结果队列包括32 913例患者，包括9438例ALD患者和23475例非ALD患者(排除了有丙型肝炎病毒感染和肝细胞癌适应症的患者)。ALD患者的中位年龄为54岁(四分位数范围，47-60岁)，而非ALD患者的中位年龄为54岁(四分位数范围，44-61岁)。ALD(vs非ALD)患者多为男性(7197/9438，76.2%)vs11767/23475(50.1%)；
IMPORTANCE Alcohol-associated liver disease (ALD) has emerged as the most common indication for liver transplant in the United States, but data on the reasons for this increase and long-term post-liver transplant outcomes among liver transplant recipients are sparse.OBJECTIVE To characterize trends and long-term outcomes of liver transplant for ALD in the United States between 2002 and 2016.DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective, national cohort study used data from the United Network for Organ Sharing database to evaluate all liver transplants performed in the United States between January 1, 2002, and December 31, 2016.MAIN OUTCOMES AND MEASURES National and regional trends in liver transplant for ALD, with a sensitivity analysis with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) included, and early (90 days after liver transplant) patient and graft survival.RESULTS The cohort consisted of 32 913 patients, including 9438 with ALD and 23 475 without ALD (patients who had HCV infection and HCC indications were excluded). Median age of patients with ALD was 54 years (interquartile range, 47-60 years) and of patients without ALD was 54 years (interquartile range, 44-61 years). Patients with ALD (vs non-ALD) were more frequently male (7197 of 9438 [76.2%] vs 11 767 of 23 475 [50.1%]; P