Hanto Douglas W, Fishbein Thomas M, Pinson C Wright, Olthoff Kim M, Shiffman Mitchell L, Punch Jeffrey D, Goodrich Nathan P
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Am J Transplant. 2005 Apr;5(4 Pt 2):916-33. doi: 10.1111/j.1600-6135.2005.00839.x.
With nearly two years of data available since the inception of the MELD and PELD allocation system, this article examines national OPTN/SRTR data to describe trends in waiting list composition, waiting list mortality, transplant rates, and patient and graft outcomes for liver transplantation. Following a 6% reduction in the size of the waiting list after MELD was implemented in 2002, the number of patients on the waiting list grew by 2% from 2002 to 2003, while the number of liver transplants increased by 6%. The overall death rate while on the liver waiting list has decreased from 225 deaths per 1,000 patient years in 1994 to 124 deaths in 2003. As with the waiting list death rates, post-transplant death rates have also decreased over the past decade. Unadjusted one-year patient survival was lower for older donor age groups (88% for donors aged 18-34, 87% for donors aged 35-49, 85% for donors aged 50-64); a similar trend was observed at three and five years following transplantation. Intestine transplantation is performed with slowly increasing frequency and success. Early graft losses and rejection rates have changed little since 1994, but rejection is easier to control and long-term survival is improving.
自终末期肝病模型（MELD）和儿童终末期肝病模型（PELD）分配系统启用以来，已有近两年的数据可用。本文研究了器官共享联合网络（OPTN）/器官获取与移植网络（SRTR）的全国数据，以描述肝移植等待名单构成、等待名单死亡率、移植率以及患者和移植物结局的趋势。2002年实施MELD后，等待名单规模减少了6%，从2002年到2003年，等待名单上的患者人数增长了2%，而肝移植数量增加了6%。肝移植等待名单上的总体死亡率已从1994年的每1000患者年225例死亡降至2003年的124例死亡。与等待名单死亡率一样，过去十年中移植后的死亡率也有所下降。年龄较大的供体组未调整的一年患者生存率较低（18 - 34岁供体为88%，35 - 49岁供体为87%，50 - 64岁供体为85%）；移植后三年和五年观察到类似趋势。肠道移植的实施频率和成功率在缓慢上升。自1994年以来，早期移植物丢失和排斥率变化不大，但排斥反应更易于控制，长期生存率正在提高。
