Outcomes for liver transplant candidates listed with low model for end-stage liver disease score
Outcomes for liver transplant candidates listed with low model for end-stage liver disease score
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DOI：
10.1002/lt.24307
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发表时间：
2015-11-01
影响因子：
4.6
通讯作者：
Roberts, John P.
中科院分区：
文献类型：
--
作者：
Kwong, Allison J.;Lai, Jennifer C.;Roberts, John P.
终末期肝病模型（MELD）评分，估计90天内的死亡率，确定肝移植（LT）的优先级。然而，对于最初以低MELD评分列出的患者，等待名单上的长期结局尚未得到很好的表征。对2005年至2012年期间在一个高容量中心登记的所有接受初次LT的成人进行了评价，这些成人的初始实验室MELD评分为22或更低。排除的是MELD例外点列出的接受活体肝移植（LDLT）或在另一家中心移植的患者，或因非医学原因从等待名单中删除的患者。结果和死亡原因由器官共享联合网络，国家死亡指数和电子病历审查确定。多变量竞争风险分析评估了与死亡供体肝移植（DDLT）相比的死亡预测因素; 2005年至2012年共列出893例患者。到随访结束时，27%的患者接受了DDLT，31%的患者因死亡或临床恶化而从等待名单中删除。在竞争性风险评估中，与DDLT相比，只有MELD评分6-9、年龄较大、血清白蛋白较低、体重指数较低和糖尿病才会增加等待名单脱落的风险。肝肾联合移植可以防止等待名单脱落。在纳入的患者中，275例患者死亡或因病情过重而被除名; 87%的可识别死亡原因与终末期肝病或肝细胞癌直接相关。总之，MELD评分低的患者仍有因肝脏相关原因死亡的显著风险，并可能从抢先体验移植中获益，如LDLT或接受高风险供体肝脏。与移植相比，死亡的预测因素可能允许早期识别处于等待名单死亡风险中的患者。肝移植21：1403-1409，2015. (c)2015年AASLD。
The Model for End-Stage Liver Disease (MELD) score, which estimates mortality within 90 days, determines priority for liver transplantation (LT). However, longer-term outcomes on the wait list for patients who are initially listed with low MELD scores are not well characterized. All adults listed for primary LT at a single, high-volume center from 2005 to 2012 with an initial laboratory MELD score of 22 or lower were evaluated. Excluded were those patients listed with MELD exception points who underwent living donor liver transplantation (LDLT) or transplantation at another center, or who were removed from the wait list for nonmedical reasons. Outcomes and causes of death were identified by United Network for Organ Sharing, the National Death Index, and an electronic medical record review. Multivariate competing risk analysis evaluated predictors of death compared to deceased donor liver transplantation (DDLT); 893 patients were listed from 2005 to 2012. By the end of follow-up, 27% had undergone DDLT, and 31% were removed from the wait list for death or clinical deterioration. In a competing risks assessment, only MELD score of 6-9, older age, lower serum albumin, lower body mass index, and diabetes conferred an increased risk of wait-list dropout compared to DDLT. Listing for simultaneous liver-kidney transplantation was protective against wait-list dropout. Of the patients included, 275 patients died or were delisted for being too sick; 87% of the identifiable causes of death were directly related to end-stage liver disease or hepatocellular carcinoma. In conclusion, patients with low listing MELD scores remain at a significant risk for death due to liver-related causes and may benefit from early access to transplantation, such as LDLT or acceptance of high-risk donor livers. Predictors of death compared to transplantation may allow for early identification of patients who are at risk for wait-list mortality. Liver Transpl 21:1403-1409, 2015. (c) 2015 AASLD.