Freeman R B, Harper A, Edwards E B
Division of Transplant Surgery, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
Transplant Proc. 2005 Mar;37(2):585-8. doi: 10.1016/j.transproceed.2004.12.099.
The MELD/PELD (M/P) system for liver allocation was implemented on February 27, 2002, in the United States. Since then sufficient time has elapsed to allow for assessment of posttransplant survival rates under this system. We analyzed 4163 deceased donor liver transplants performed between February 27, 2002, and December 31, 2003, for whom follow-up reporting was 95% and 67% complete at 6 and 12 months, respectively. Kaplan-Meier survival analysis revealed 1-year patient and graft survival rates for status 1 of 76.9% and 70.4%, respectively, and 87.3% and 82.9% for patients prioritized by M/P (P < .0001 for status 1 vs M/P). When adult candidates were stratified by MELD score quartile at transplant, 1-year survival rates were 89.5%, 88.3%, 86.6%, and 78.1% for lowest to highest quartile (P = .0002) and graft survival rates were similarly distributed (85.0%, 84.5%, 82.7%, 73.0%, P < .0001). Candidates with hepatocellular cancer (89.6%) and other MELD score exceptions (88.8%) had slightly higher 1-year survival rates compared with standard MELD recipients (86.0%), which did not reach statistical significance (P = .089). Pediatric recipients had slightly better patient (88.7%) and graft (86.5%) survival rates at 1 year than adults but there were no significant differences among the PELD strata due to small numbers of patients in each PELD quartile. We conclude that patient and graft survival have remained excellent since implementation of the MELD/PELD system. Although recipients with MELD scores in the highest quartile have reduced survival compared with other quartiles, their 1-year survival rate is acceptable when their extreme risk of dying without a transplant is taken into consideration.
美国于2002年2月27日实施了肝脏分配的终末期肝病模型/小儿终末期肝病模型（MELD/PELD，M/P）系统。自那时起，已有足够的时间来评估该系统下的移植后生存率。我们分析了2002年2月27日至2003年12月31日期间进行的4163例已故供体肝脏移植，6个月和12个月时随访报告的完整性分别为95%和67%。Kaplan-Meier生存分析显示，状态1患者和移植物的1年生存率分别为76.9%和70.4%，M/P优先排序患者的1年生存率分别为87.3%和82.9%（状态1与M/P相比，P<0.0001）。当成年候选者按移植时的MELD评分四分位数分层时，最低至最高四分位数的1年生存率分别为89.5%、88.3%、86.6%和78.1%（P=0.0002），移植物生存率也呈类似分布（85.0%、84.5%、82.7%、73.0%，P<0.0001）。肝细胞癌患者（89.6%）和其他MELD评分例外患者（88.8%）的1年生存率略高于标准MELD受者（86.0%），但未达到统计学显著性（P=0.089）。小儿受者1年时的患者生存率（88.7%）和移植物生存率（86.5%）略高于成人，但由于每个PELD四分位数中的患者数量较少，PELD各分层之间无显著差异。我们得出结论，自MELD/PELD系统实施以来，患者和移植物的生存率一直保持良好。尽管MELD评分处于最高四分位数的受者与其他四分位数相比生存率有所降低，但考虑到他们在不进行移植情况下极高的死亡风险，其1年生存率是可以接受的。
