Liver Transplant Listing in Pediatric Acute Liver Failure: Practices and Participant Characteristics.
Liver Transplant Listing in Pediatric Acute Liver Failure: Practices and Participant Characteristics.
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DOI：
10.1002/hep.30116
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Squires RH
中科院分区：
文献类型：
--
作者：
Squires JE;Rudnick DA;Hardison RM;Horslen S;Ng VL;Alonso EM;Belle SH;Squires RH
小儿急性肝衰竭（PALF）的肝移植（LT）决定是复杂的。PALF登记的三个阶段，包含1144名参与者超过15年的数据，被询问以表征与上市状态相关的临床特征。用药累计发生率（CI）下降（p<0.005），接受LT治疗（p<0.05），但死亡CI升高（p=0.67）。上市时间不变，较早（1天；Q1-Q3= 0-2; p=0.88）。未列入名单的最常见理由是“病得不够严重”和“医学上不合适”。被列入LT的参与者更有可能是男性，昏迷等级得分为bb0 ~ 0；较高的INR、胆红素、乳酸和静脉氨；与那些被认为“病得不够严重”的人相比，他们的外周血淋巴细胞和转氨酶水平较低。列出的参与者与被认为“医学上不合适”的参与者年龄较大，血清转氨酶水平、胆红素、血小板和白蛋白水平较高；乳酸、静脉氨和淋巴细胞计数降低。不确定的诊断在名单上的参与者中更为普遍。呼吸机（23.8%）和血管加压剂（9.2%）支持在列出的参与者中有很大一部分出现，但比那些“医学上不合适”的参与者更少。从LT名单上除名是一件罕见的事情。在整个PALF研究中，登记和接受肝移植的CI下降，但死亡CI没有增加。虽然所有参与者都符合PALF的入组标准，但在LT参与者与被认为“病情不够严重”的参与者以及“医学上不适合”的参与者之间存在显著差异。诊断不明确和需要心肺支持似乎影响了上市的决定。优化PALF的清单决策可以在不增加死亡频率的情况下降低LT的频率。
Liver transplant (LT) decisions in pediatric acute liver failure (PALF) are complex. Three phases of the PALF registry, containing data on 1144 participants over 15 years, were interrogated to characterize clinical features associated with listing status. A decrease in the cumulative incidence (CI) of listing (p<0.005) and receiving (p<0.05) LT occurred without an increase in the CI of death (p=0.67). Time-to listing was constant, and early (1 day; Q1-Q3=0–2; p=0.88). The most frequent reasons for not listing were “not sick enough” and “medically unsuitable”. Participants listed for LT were more likely male, with coma grade scores >0; higher INR, bilirubin, lactate, and venous ammonia; and had lower peripheral lymphocytes and transaminase levels compared to those deemed “not sick enough”. Participants listed vs those deemed “medically unsuitable” were older, with higher serum aminotransferase levels, bilirubin, platelets, and albumin; with lower lactate, venous ammonia, and lymphocyte count. An indeterminate diagnosis was more prevalent in listed participants. Ventilator (23.8%) and vasopressor (9.2%) support occurred in a significant portion of listed participants, but less frequently than those who were not “medically suitable”. Removal from the LT list was a rare event. The CI of listing for and receiving LT decreased throughout the PALF study without an increase in the CI of death. While all participants fulfilled entry criteria for PALF, significant differences were noted between participants listed for LT versus those deemed “not sick enough” as well as those who were “medically unsuitable”. Having an indeterminate diagnosis and a requirement for cardiopulmonary support appeared to influence decisions toward listing. Optimizing listing decisions in PALF may reduce the frequency of LT without increasing the frequency of death.
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DOI：
10.1111/ajt.13197
发表时间：
2015-01-01
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Kim, W R;Lake, J R;Kasiske, B L
通讯作者：
Kasiske, B L
影响因子：
5.1
作者：
Lu, Brandy R.;Zhang, Song;Sokol, Ronald J.
通讯作者：
Sokol, Ronald J.
影响因子：
8
作者：
Leonis, Mike A.;Alonso, Estella M.;Squires, Robert H.
通讯作者：
Squires, Robert H.
影响因子：
2.5
作者：
Bagchi, A.;Kumar, S.;Kar, P.
通讯作者：
Kar, P.
影响因子：
5.7
作者：
Zamora, Ruben;Vodovotz, Yoram;Squires, Robert H.
通讯作者：
Squires, Robert H.