Projected 20- and 30-Year Outcomes for Pediatric Liver Transplant Recipients in the United States.
Projected 20- and 30-Year Outcomes for Pediatric Liver Transplant Recipients in the United States.
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DOI：
10.1097/mpg.0000000000002592
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发表时间：
2020-03
影响因子：
2.9
通讯作者：
Mogul DB
中科院分区：
文献类型：
--
作者：
Bowring MG;Massie AB;Chu NM;Bae S;Schwarz KB;Cameron AM;Bridges JFP;Segev DL;Mogul DB
观察到的长期结果不再反映当今儿童肝移植（LT）受者的生存轨迹。我们的目的是使用国家登记数据和参数模型来预测最近移植的儿童肝移植受者移植后20年和30年的结果。我们对13442例首次儿科（年龄<18岁）肝移植受者进行了回顾性队列研究，使用了1987年至2018年移植受者科学登记处的数据。我们在两个历史队列（1987-1996年和1997-2006年）中验证了所提出的方法（即使用参数生存模型和短期数据预测患者和移植物的长期生存），并估计了2007年至2018年移植患者的长期预测。根据移植物类型、受体年龄和移植指征对投影进行分层。具有威布尔分布的简约参数模型可应用于移植后数据，并用于预测儿科肝移植受者的长期预后。2007年至2018年移植的儿童肝移植受体的20年预期生存率为84.0%(95%可信区间为81.5-85.8)，而1997年至2006年和1987年至1996年移植的儿童肝移植受体的20年预期生存率分别为72.8%和63.6%。2007年至2018年，儿科肝移植接受者的30年预期生存率为80.1%(75.2-82.7)，而1997年至2006年队列的30年预期生存率为68.6%(66.1-70.9)，1987年至1996年队列的30年预期生存率为57.5%。20岁和30岁的患者和移植物存活率因受者年龄、移植物类型和移植指征而略有不同。近期移植的儿童肝移植受者的远期预后非常好，反映了医疗保健的实质性改善，并为当前时代的医患教育和决策提供了信息。
Observed long-term outcomes no longer reflect the survival trajectory facing pediatric liver transplant (LT) recipients today. We aimed to use national registry data and parametric models to project 20- and 30-year post-transplant outcomes for recently transplanted pediatric LT recipients. We conducted a retrospective cohort study of 13,442 first-time pediatric (age <18) LT recipients using 1987 to 2018 Scientific Registry of Transplant Recipients data. We validated the proposed method (ie, to project long-term patient and graft survival using parametric survival models and short-term data) in 2 historic cohorts (1987–1996 and 1997–2006) and estimated long-term projections among patients transplanted between 2007 and 2018. Projections were stratified by graft type, recipient age, and indication for transplant. Parsimonious parametric models with Weibull distribution can be applied to post-transplant data and used to project long-term outcomes for pediatric LT recipients beyond observed data. Projected 20-year patient survival for pediatric LT recipients transplanted in 2007 to 2018 was 84.0% (95% confidence interval 81.5–85.8), compared to observed 20-year survival of 72.8% and 63.6% among those transplanted in 1997 to 2006 and 1987 to 1996, respectively. Projected 30-year survival for pediatric LT recipients in 2007 to 2018 was 80.1% (75.2–82.7), compared to projected year survival of 68.6% (66.1–70.9) in the 1997 to 2006 cohort and observed 30-year survival of 57.5% in the 1987 to 1996 cohort. Twenty- and 30-year patient and graft survival varied slightly by recipient age, graft type, and indication for transplant. Projected long-term outcomes for recently transplanted pediatric LT recipients are excellent, reflective of substantial improvements in medical care, and informative for physician-patient education and decision making in the current era.