OPTN/SRTR 2017 Annual Data Report: Liver.
OPTN/SRTR 2017 Annual Data Report: Liver.
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DOI：
10.1111/ajt.15276
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发表时间：
2019-02-01
期刊：
影响因子：
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通讯作者：
Kasiske, B L
中科院分区：
文献类型：
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作者：
Kim, W R;Lake, J R;Kasiske, B L
2017 年美国进行的成人肝移植数据值得注意的是：(1) 新候补注册人数 (11,514) 和进行的移植数量 (8,082) 持续增长； (2) 移植率持续上升（每 100 等待年 51.5 例）； (3) 丙型肝炎相关适应症的候补登记和移植急剧减少； (4) 患有酒精性肝病且临床特征与非酒精性脂肪肝病一致的候补登记者和接受者数量相互增加； (5) 尽管受者特征发生变化，例如年龄较大和肥胖率较高，但移植物存活率持续改善。移植率仍因候选种族、是否存在肝细胞癌、紧急状态（状态 1A 与终末期肝病模型 (MELD) 评分 >35）和地理位置而存在差异。 2017年列入肝移植的所有儿童中有一半以上年龄在5岁以下，移植前死亡率最高的儿童仍然是1岁以下的儿童。儿童接受移植的敏锐度比过去更高，更高的 MELD/儿童终末期肝病评分以及 1A 和 1B 状态列表就证明了这一点。移植时较高的敏锐度可能是由于缺乏合适的供体器官，而使用部分或分裂肝移植物和 ABO 不相容移植物的持续趋势弥补了这一点。尽管移植时疾病严重程度评分较高，但随着时间的推移，儿科移植物和患者移植后的存活率有所改善。
Data on adult liver transplants performed in the US in 2017 are notable for (1) continued growth in numbers of new waitlist registrants (11,514) and of transplants performed (8,082); (2) continued increase in the transplant rate (51.5 per 100 waitlist-years); (3) a precipitous decrease in waitlist registrations and transplants for hepatitis C-related indications; (4) reciprocal increases in waitlist registrants and recipients with alcoholic liver disease and with clinical profiles consistent with non-alcoholic fatty liver disease; and (5) continued improvement in graft survival despite changing recipient characteristics such as older age and higher rates of obesity. Variability in transplant rates remained by candidate race, presence of hepatocellular carcinoma, urgency status (status 1A versus model for end-stage liver disease (MELD) score >35), and geography. More than half of all children listed for liver transplant in 2017 were aged younger than 5 years in 2017, and the highest rate of pretransplant mortality persisted for children aged younger than 1 year. Children underwent transplant at higher acuity than the past, as evidenced by higher MELD/pediatric end-stage liver disease scores and listings at status 1A and 1B. Higher acuity at transplant is likely due to lack of access to suitable donor organs, which has been compensated for by persistent trends toward use of partial or split liver grafts and ABO-incompatible grafts. Despite higher illness severity scores at transplant, pediatric graft and patient survival posttransplant have improved over time.