Recipient characteristics and morbidity and mortality after liver transplantation
Recipient characteristics and morbidity and mortality after liver transplantation
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DOI：
10.1016/j.jhep.2018.02.004
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发表时间：
2018-07-01
影响因子：
25.7
通讯作者：
Trotter, James
中科院分区：
文献类型：
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作者：
Asrani, Sumeet K.;Saracino, Giovanna;Trotter, James
背景和目标：在过去的十年中，美国对患有多种合并症的病情较重、老年非丙型肝炎肝硬化患者的肝移植有所增加。我们试图在 HCV 阴性成人移植受者中确定一组易于应用的受者因素，这些因素与肝移植后五年内的显着发病率和死亡率相关。方法：我们收集了国家（n = 31,829，2002-2015）和中心特定数据。相关接收因素的系数被转换为加权点并从0-5缩放。与移植失败相关的受者因素包括：呼吸机支持（5 名患者；风险比 [HR] 1.59；95% CI 1.48-1.72）；接受者年龄 > 60 岁（三名患者；HR 1.29；95% CI 1.23-1.36）；血液透析（三名患者；HR 1.26；95% CI 1.16-1.37）；糖尿病（两名患者；HR 1.20；95% CI 1.14-1.27）；或血清肌酐 >= 1.5 mg/dl，无需进行血液透析（两名患者；HR 1.15；95% CI 1.09-1.22）。结果：基于评分（任何组合）的五年内移植物存活率为 77.2% (0-4)、69.1% (5-8) 和 57.9% (>8)。在大于 8 分的受者中，移植物存活率为 42%（终末期肝病模型 [MELD] 评分 1.7）。在第一年内的中心特定数据中，大于等于 5 分（相对于 0-4）的受试者住院时间较长（11 天与 8 天，p
Background and Aims: Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple comorbidities has increased in the United States. We sought to identify an easily applicable set of recipient factors among HCV negative adult transplant recipients associated with significant morbidity and mortality within five years after liver transplantation.Methods: We collected national (n = 31,829, 2002-2015) and center-specific data. Coefficients of relevant recipient factors were converted to weighted points and scaled from 0-5. Recipient factors associated with graft failure included: ventilator support (five patients; hazard ratio [HR] 1.59; 95% CI 1.48-1.72); recipient age >60 years (three patients; HR 1.29; 95% CI 1.23-1.36); hemodialysis (three patients; HR 1.26; 95% CI 1.16-1.37); diabetes (two patients; HR 1.20; 95% CI 1.14-1.27); or serum creatinine >= 1.5 mg/dl without hemodialysis (two patients; HR 1.15; 95% CI 1.09-1.22).Results: Graft survival within five years based on points (any combination) was 77.2% (0-4), 69.1% (5-8) and 57.9% (>8). In recipients with >8 points, graft survival was 42% (model for end-stage liver disease [MELD] score 1.7. In center-specific data within the first year, subjects with >= 5 points (vs. 0-4) had longer hospitalization (11 vs. 8 days, p