Trzepacz P T, DiMartini A
University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pennsylvania 15213.
Gen Hosp Psychiatry. 1992 Nov;14(6):380-6. doi: 10.1016/0163-8343(92)90005-u.
We retrospectively gathered survival data for a cohort of previously published, prospectively studied liver transplantation candidates. Of the 247 candidates in the original cohort, 130 were transplanted at our hospital. The 117 who were not transplanted were older, had significantly more cognitive impairment on Trailmaking Tests and slowing on electroencephalogram (EEG), and had more delirium (25% vs 15%); they also had significantly more impairment in family relationships prior to transplant. Of the 130 patients who were transplanted, 91 survived as of December 1989 and 39 did not. None of the cognitive, EEG, or serum albumin results differentiated these groups, nor did age or incidence of pretransplant delirium (21% of those who died vs 12% of survivors). However, the highest level of adaptive functioning in the year prior to candidacy evaluation was significantly better in survivors; and there was more family and social dysfunction in nonsurvivors. Though the nonsurvivors received significantly more livers, histocompatibility did not distinguish the groups. The presence or absence of delirium did not predict survival status or duration for the whole group of transplanted patients. However, for the subgroup of transplant survivors, delirious patients had significantly shorter waits for transplantation and longer survival times than nondelirious ones.
我们回顾性收集了一组先前发表的、经过前瞻性研究的肝移植候选者的生存数据。在最初队列中的247名候选者中，有130人在我们医院接受了移植。未接受移植的117人年龄较大，在连线测验中认知障碍显著更多，脑电图（EEG）显示有减慢现象，且谵妄更多（25%对15%）；他们在移植前家庭关系方面的损害也显著更多。在接受移植的130名患者中，截至1989年12月，91人存活，39人未存活。认知、脑电图或血清白蛋白结果均未区分这些组，年龄或移植前谵妄的发生率也未区分（死亡者中有21%，存活者中有12%）。然而，候选资格评估前一年的最高适应功能水平在存活者中显著更好；非存活者存在更多的家庭和社会功能障碍。尽管非存活者接受的肝脏显著更多，但组织相容性并未区分这些组。谵妄的存在与否并不能预测整个移植患者组的生存状态或持续时间。然而，对于移植存活者亚组，谵妄患者等待移植的时间显著更短，存活时间比非谵妄患者更长。
