Liver transplantation for hepatocellular cancer: The impact of the MELD allocation policy
Liver transplantation for hepatocellular cancer: The impact of the MELD allocation policy
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DOI：
10.1053/j.gastro.2004.09.040
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发表时间：
2004-11-01
期刊：
影响因子：
29.4
通讯作者：
Mulligan, DC
中科院分区：
文献类型：
--
作者：
Wiesner, RH;Freeman, RB;Mulligan, DC
最近的报道表明，选择性的接受肝移植治疗1-2期肝细胞癌（HCC）的患者具有良好的长期生存率和低复发率。过去，在器官共享联合网络/器官采购移植网络等待名单上，超过45%的肝癌患者长达2年没有接受捐赠器官。这不仅导致高死亡率，而且由于HCC进展到晚期而从等待名单中移除的比率也很高。终末期肝病模型（MELD）分配政策的引入对HCC肝移植候选人产生了积极影响，在过去几年中，HCC移植患者的数量显着增加。此外，肝细胞癌患者接受已故捐赠者的等待时间显着减少，因晚期疾病而退出等待名单的患者人数也有所减少。MELD分配政策的早期评估表明，肝细胞癌患者的移植后生存期与MELD前和后的比较是相似的。利用我们收集的关于MELD分配政策的数据，我们已经对HCC患者的MELD分配政策进行了修改。希望通过持续的数据收集和评估，能够达成共识，进一步优化HCC受者中死亡供体的使用。
Recent reports suggest that selected patients undergoing liver transplantation for stage 1-2 hepatocellular cancer (HCC) have an excellent long-term survival and a low incidence of recurrence. In the past, over 45% of HCC patients on the United Network for Organ Sharing/ Organ Procurement Transplantation Network waiting list did not receive a donor organ for up to 2 years. This resulted in not only a high mortality rate but a high rate of being removed from the waiting list because of progression of HCC to advanced stages. The introduction of the Model for End-Stage Liver Disease (MELD) allocation policy has had a positive effect on HCC liver transplant candidates with the number of patients transplanted for HCC significantly increasing over the past several years. In addition, waiting time for HCC patients to receive a deceased donor has decreased significantly and the number of patients dropping out from the waiting list because of advanced stage disease has also decreased. An early assessment of the MELD allocation policy suggests that posttransplant survival for HCC patients comparing pre-MELD to post-MELD eras is similar. Using the data we have collected on the MELD allocation policy, we have already made modifications to the MELD allocation policy for HCC patients. It is hoped that through continued data collection and assessment, a consensus can be reached to further optimize the use of deceased donors in HCC recipients.