Austin Gregory L, Sasaki Anna W, Zaman Atif, Rabkin John M, Olyaei Ali, Ruimy Roberta, Orloff Susan L, Ham John, Rosen Hugo R
Department of Medicine, Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR, USA.
Am J Transplant. 2004 May;4(5):788-95. doi: 10.1111/j.1600-6143.2004.00388.x.
The purpose of this study was to evaluate whether there was a difference in mortality following orthotopic liver transplantation (OLT) in a US veteran (VA) population (n = 149) compared to a non-VA (university) population (n = 285) and what factors could explain this difference. Survival following OLT for 149 VA patients was compared with that of 285 university patients. By Kaplan-Meier survival analysis, VA patients had higher mortality than university patients with respective 1-year, 3-year, and 5-year survival of 82%, 75%, and 68% vs. 87%, 82%, and 78% (p = 0.006). Gender, etiology of end-stage liver disease (ESLD) and donor age (i.e. older than 34 years) also significantly influenced survival. However, when donor and recipient age, gender, model for end-stage liver disease (MELD) score, and etiology of liver disease were included with hospital status in a multivariate Cox proportional hazards model, the VA population did not have higher mortality. A final model to predict mortality following transplantation was derived for all 434 patients where individuals were assigned risk scores based on the equation R = 0.219 (gender) + 0.018 (donor age) + 0.032 (recipient age) + 0.021 (MELD), where recipient age, donor age, and MELD score are the respective continuous variables and gender = 1 (men) and 0 for women (c-statistic = 0.71).
本研究的目的是评估在美国退伍军人（VA）群体（n = 149）与非VA（大学）群体（n = 285）中，原位肝移植（OLT）后死亡率是否存在差异，以及哪些因素可以解释这种差异。将149例VA患者OLT后的生存率与285例大学患者的生存率进行比较。通过Kaplan-Meier生存分析，VA患者的死亡率高于大学患者，其1年、3年和5年生存率分别为82%、75%和68%，而大学患者分别为87%、82%和78%（p = 0.006）。性别、终末期肝病（ESLD）病因和供体年龄（即大于34岁）也显著影响生存率。然而，当在多变量Cox比例风险模型中将供体和受体年龄、性别、终末期肝病模型（MELD）评分以及肝病病因与医院状态纳入分析时，VA群体的死亡率并没有更高。为所有434例患者推导了一个预测移植后死亡率的最终模型，根据公式R = 0.219（性别）+ 0.018（供体年龄）+ 0.032（受体年龄）+ 0.021（MELD）为个体分配风险评分，其中受体年龄、供体年龄和MELD评分是各自的连续变量，性别 = 1（男性），女性 = 0（c统计量 = 0.71）。
