Outcomes of adult liver re-transplant patients in the model for end-stage liver disease era: is it time to reconsider its indications?
Outcomes of adult liver re-transplant patients in the model for end-stage liver disease era: is it time to reconsider its indications?
复制标题
终末期肝病时代模型中成人肝再移植患者的结果：是时候重新考虑其适应症了吗？
DOI：
10.1111/ctr.12423
复制
发表时间：
2014
影响因子：
2.1
通讯作者：
Dick,AndréAS
中科院分区：
文献类型：
--
作者：
Montenovo,MartinI;Hansen,RyanN;Dick,AndréAS
目的更好地了解非丙型肝炎患者再次肝移植的结果和效用，我们试图确定影响移植后患者和移植物存活率的预测因素，将初次肝移植患者与接受后续同种异体移植的患者进行比较。方法我们使用器官共享联合网络数据库从2002年2月至2012年12月进行回顾性队列分析，包括接受初次和重复肝移植的非丙型肝炎感染成年人（18岁及以上）。使用Kaplan-Meier估计值比较两组患者和移植物存活率。构建考克斯比例风险模型来评估与患者和移植物存活率相关的变量。ResultsWe确定了33176例初次移植受者和2710例再次移植。再次移植患者更可能在移植前接受透析（18% vs. 10%），住院（26% vs. 16%），在重症监护室（ICU）（34% vs. 13%），使用呼吸机（17% vs. 3%），并且具有较高的终末期肝病模型（MELD）评分（27 vs. 21）。再次移植也接受了供体风险指数（DRI）较低的肝脏（1.57 vs. 1.64）。我们估计调整后的风险比（HR）为1.7（95%CI：1.56-1.84）和1.61（95%CI：1.5-1.73）的患者生存和移植物survival.ConclusionsLiver re-transplantation在非丙型肝炎患者，虽然挽救生命，有显着较差的患者和移植物生存相比，原发性肝移植。较高质量的移植物在病情较重的患者人群中使用效率较低，这表明更优化的策略可能包括将其用于获得长期受益的患者。
ObjectiveTo better understand the outcomes and utility of liver re‐transplantation in non‐hepatitis C patients, we sought to identify predictors that impact post‐transplant patient and graft survival comparing primary liver transplant patients to those receiving subsequent allografts.MethodsWe conducted a retrospective cohort analysis using the United Network for Organ Sharing database from February 2002 through December 2012, including non‐hepatitis C infected adults (18 yr and older) who underwent primary and repeat liver transplantation. Patient and graft survival were compared between the two groups using the Kaplan–Meier estimator. Cox proportional hazards models were constructed to evaluate variables associated with both patient and graft survival.ResultsWe identified 33 176 primary transplant recipients and 2710 re‐transplants. Re‐transplantation patients were more likely to be on dialysis prior to transplant (18% vs. 10%), hospitalized (26% vs. 16%), in the intensive care unit (ICU) (34% vs. 13%), on a ventilator (17% vs. 3%), and had higher model for end‐stage liver disease (MELD) score (27 vs. 21). Re‐transplants also received livers with a lower donor risk index (DRI) (1.57 vs. 1.64). We estimated an adjusted hazard ratio (HR) of 1.7 for patient survival (95% CI: 1.56–1.84) and 1.61 (95% CI: 1.5–1.73) for graft survival.ConclusionsLiver re‐transplantation in non‐hepatitis C patients, although life saving, has significantly inferior patient and graft survival compared to primary liver transplantation. Higher quality grafts are used inefficiently in a sicker patient population, suggesting that a more optimal strategy may include restricting their use to patients who obtain a longer term benefit.