Alali Jaber, Ramji Alnoor, Ho Jin K, Scudamore Charles H, Erb Siegfried R, Cheung Elsie, Kopit Bina, Bannon Clare A, Chung Stephen W, Soos John G, Buczkowski Andrezj K, Brooks Eileen M, Steinbrecher Urs P, Yoshida Eric M
Department of Medicine, University of British Columbia.
Can J Gastroenterol. 2006 Feb;20(2):95-9. doi: 10.1155/2006/879103.
Every centre has contraindications to liver transplantation and declares patients unsuitable for medical or nonmedical reasons. To date, there has been no published review of any centre's experience.
A retrospective chart review was completed from 1997 to 2001, inclusive of all patients referred for liver transplant to the British Columbia Transplant Society who were declared unsuitable for transplantation, as well as the reasons for unsuitability.
One hundred fifty patients were considered to be unsuitable for transplantation. During this period, 167 transplants were performed and 737 patients were referred for candidacy. Data were missing on three patients; analysis was performed on the remaining 147. Patients' ages ranged from 15 to 72 years, and 33.3% were female. The most common primary liver disease was hepatitis C (n=53, 35%), followed by alcoholic liver disease (n=35, 24%) and autoimmune liver diseases (n=23, 16%). Medical contraindications constituted 74 patients (49.0%) and the most common reasons for unsuitability were no need of a liver transplant (29 patients [39%]), exclusion due to hepatoma or extrahepatic malignancy (20 patients [27%]) and multisystem failure (12 patients [16%]). Nonmedical contraindications constituted 73 patients. Failure to meet minimal alcohol criteria comprised the largest group (n=39, 53.4%) followed by inadequate social support (n=12, 16.4%), failure to follow up medical assessment (n=10, 13.7%) and drug abuse (n=6, 8.2%).
Although many patients were declined for transplantation, the proportion is relatively small compared with the number of referred patients. Nonmedical reasons, including failure to meet alcohol criteria and lack of social support, remain a significant reason for unsuitability in British Columbia. Community intervention before transplant referral is recommended.
每个中心都有肝移植的禁忌症，并会因医学或非医学原因宣布患者不适合进行移植。迄今为止，尚未有关于任何中心经验的公开综述。
对1997年至2001年期间进行了回顾性病历审查，涵盖所有转介至不列颠哥伦比亚移植协会进行肝移植但被宣布不适合移植的患者及其不适合的原因。
150名患者被认为不适合移植。在此期间，共进行了167例移植手术，737名患者被转介评估是否适合移植。有3名患者的数据缺失；对其余147名患者进行了分析。患者年龄在15岁至72岁之间，33.3%为女性。最常见的原发性肝病是丙型肝炎（n = 53，35%），其次是酒精性肝病（n = 35，24%）和自身免疫性肝病（n = 23，16%）。医学禁忌症患者有74例（49.0%），最常见的不适合原因是无需进行肝移植（29例[39%]）、因肝癌或肝外恶性肿瘤被排除（20例[27%]）以及多系统衰竭（12例[16%]）。非医学禁忌症患者有73例。未达到最低酒精标准的患者占最大比例（n = 39，53.4%），其次是社会支持不足（n = 12，16.4%）、未完成医学评估随访（n = 10，13.7%）和药物滥用（n = 6，8.2%）。
尽管许多患者被拒绝移植，但与转介患者数量相比，这一比例相对较小。在不列颠哥伦比亚省，包括未达到酒精标准和缺乏社会支持在内的非医学原因仍是不适合移植的重要原因。建议在转介移植前进行社区干预。
