The Model for End-Stage Liver Disease Allocation System for Liver Transplantation Saves Lives, but Increases Morbidity and Cost: A Prospective Outcome Analysis
The Model for End-Stage Liver Disease Allocation System for Liver Transplantation Saves Lives, but Increases Morbidity and Cost: A Prospective Outcome Analysis
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DOI：
10.1002/lt.22228
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发表时间：
2011-06-01
影响因子：
4.6
通讯作者：
Clavien, Pierre-Alain
中科院分区：
文献类型：
--
作者：
Dutkowski, Philipp;Oberkofler, Christian E.;Clavien, Pierre-Alain
我们通过终末期肝脏疾病模型（MELD）分配分析了前100名接受肝移植的患者，并将等待名单上和原位肝移植后的患者的结果与引入之前接受移植的最后100名患者的结果进行了比较MELD系统于2007年7月推出。MELD分配降低了等待名单死亡率（386对242例死亡/1000患者-年，P < 0.0001）和病情较重受者的移植（未校正的MELD评分中位数13.5对20，P = 0.003）。移植后并发症明显增加，主要是由于需要肾脏替代治疗的肾功能衰竭比例增加（13%对46%，P < 0.0001）。但大多数病例术后6个月内肾功能恢复。两组的住院死亡率相似（6% vs 9%）。患者1年生存率分别为91%和83%（MELD前与MELD时代，P = 0.2154），移植物1年生存率分别为88%和78%（P = 0.1013）。引入MELD政策后，累积成本显著较高（81，967美元对127，453美元，增加55%，P = 0.02），与个体MELD评分密切相关（P < 0.0001）。MELD系统很好地解决了公平的目标。然而，在MELD时代，随着经济负担的增加，术后病程似乎更加困难，但患者和移植物存活率合理。这是肝移植分配中平衡公正和效用的必然代价。肝移植17：674-684，2011。(C)2011年AASLD。
We analyzed the first 100 patients who underwent liver transplantation by Model for End-Stage Liver Disease (MELD) allocation, and compared the outcome of patients on the waiting list and after orthotopic liver transplantation with the last 100 patients who underwent transplantation prior to the introduction of the MELD system in July 2007. MELD allocation resulted in decreased waiting list mortality (386 versus 242 deaths per 1000 patient-years, P < 0.0001) and the transplantation of sicker recipients (uncorrected median MELD score 13.5 versus 20, P = 0.003). Recipient posttransplant morbidity was significantly higher, mainly caused by increased percentage of renal failure requiring renal replacement therapy (13 versus 46%, P < 0.0001). However, kidney function recovered in most cases within 6 months after OLT. Hospital mortality remained similar in both groups (6% versus 9%). Patient 1-year survival was 91% versus 83% (pre-MELD versus MELD era, P = 0.2154), graft 1-year survival was 88% versus 78% (P = 0.1013), respectively. Costs accumulated were significantly higher after introduction of the MELD policy (US $81,967 versus US $127,453, a 55% increase, P = 0.02) with a strong correlation with the individual MELD score (P < 0.0001). The MELD system addresses the goal of fairness well. However, the postoperative course appears more difficult in the MELD era with increased financial burden, but reasonable patient and graft survival. This is the inevitable price to balance justice and utility in liver graft allocation. Liver Transpl 17:674-684, 2011. (C) 2011 AASLD.