The Impact of Increased Allocation Priority for Children Awaiting Liver Transplant: A Liver Simulated Allocation Model (LSAM) Analysis.
The Impact of Increased Allocation Priority for Children Awaiting Liver Transplant: A Liver Simulated Allocation Model (LSAM) Analysis.
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增加分配优先级对等待肝移植的儿童的影响：肝脏模拟分配模型（LSAM）分析。
DOI：
10.1097/mpg.0000000000002287
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发表时间：
2019
影响因子：
2.9
通讯作者：
Hsu,Evelyn
中科院分区：
文献类型：
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作者：
Perito,EmilyR;Mogul,DouglasB;VanDerwerken,Douglas;Mazariegos,George;Bucuvalas,John;Book,Linda;Horslen,Simon;Kim,HeungB;Miloh,Tamir;Ng,Vicky;Reyes,Jorge;Rodriguez-Davalos,ManuelI;Valentino,PamelaL;Gentry,Sommer;Hsu,Evelyn
目的：该研究的目的是调查优先考虑婴儿、儿童、青少年和病情最严重的成年人（状态1）对已故捐赠肝脏的影响。我们比较了两个“SharePeds”分配方案下的结果，该方案优先考虑儿童和1级成人进行国家共享，并增加了对儿科捐赠者或所有35岁以下捐赠者的访问，并根据器官采购和移植网络于2017年12月批准的分配计划进行了结果。（器官获取和移植网络[OPTN] 12-2017）。方法：2017年肝脏模拟分配模型和移植受体的科学登记数据对所有美国肝移植候选人和肝脏提供7/2013至6/2016年用于预测OPTN 12-2017和SharePeds schema.Results下的等待名单死亡、移植和移植后死亡。结果：优先考虑全国与儿童共享儿科供体肝脏（SharePeds 1）将减少婴儿（< 2岁，P= 0.0003）和儿童（2-11岁，P= 0.001）的等待名单死亡，成人无显著变化（P= 0.13）。优先考虑所有年龄小于35岁的已故供体肝脏与儿童和1A级成人（SharePeds 2）的国家共享将减少婴儿，儿童和所有1A/B级患者的等待名单死亡（P< 0.0001）。与OPTN-2017方案相比，SharePeds 1和2将增加婴儿，儿童和青少年的肝移植数量（所有年龄组P< 0.00005）。这两个SharePeds方案将增加儿科肝脏移植到儿科recipients.Conclusions的百分比：候补死亡人数可以显着减少，肝移植增加，为儿童和最患病的成年人，优先考虑儿童的儿科肝脏和更广泛的国家共享死者供体肝脏。
Objective:The aim of the study was to investigate the impact of prioritizing infants, children, adolescents, and the sickest adults (Status 1) for deceased donor livers. We compared outcomes under two “SharePeds” allocation schema, which prioritize children and Status 1 adults for national sharing and enhanced access to pediatric donors or all donors younger than 35 years, to outcomes under the allocation plan approved by the Organ Procurement and Transplant Network in December 2017 (Organ Procurement and Transplantation Network [OPTN] 12-2017).Methods:The 2017 Liver Simulated Allocation Model and Scientific Registry of Transplant Recipients data on all US liver transplant candidates and liver offers 7/2013 to 6/2016 were used to predict waitlist deaths, transplants, and post-transplant deaths under the OPTN 12-2017 and SharePeds schema.Results:Prioritizing national sharing of pediatric donor livers with children (SharePeds 1) would decrease waitlist deaths for infants (< 2 years, P= 0.0003) and children (2–11 years, P= 0.001), with no significant change for adults (P= 0.13). Prioritizing national sharing of all younger than 35-year-old deceased donor livers with children and Status 1A adults (SharePeds 2) would decrease waitlist deaths for infants, children, and all Status 1A/B patients (P< 0.0001 for each). SharePeds 1 and 2 would increase the number of liver transplants done in infants, children, and adolescents compared to the OPTN-2017 schema (P< 0.00005 for all age groups). Both SharePeds schema would increase the percentage of pediatric livers transplanted into pediatric recipients.Conclusions:Waitlist deaths could be significantly decreased, and liver transplants increased, for children and the sickest adults, by prioritizing children for pediatric livers and with broader national sharing of deceased donor livers.