Feng S, Goodrich N P, Bragg-Gresham J L, Dykstra D M, Punch J D, DebRoy M A, Greenstein S M, Merion R M
Department of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, California, USA.
Am J Transplant. 2006 Apr;6(4):783-90. doi: 10.1111/j.1600-6143.2006.01242.x.
Transplant physicians and candidates have become increasingly aware that donor characteristics significantly impact liver transplantation outcomes. Although the qualitative effect of individual donor variables are understood, the quantitative risk associated with combinations of characteristics are unclear. Using national data from 1998 to 2002, we developed a quantitative donor risk index. Cox regression models identified seven donor characteristics that independently predicted significantly increased risk of graft failure. Donor age over 40 years (and particularly over 60 years), donation after cardiac death (DCD), and split/partial grafts were strongly associated with graft failure, while African-American race, less height, cerebrovascular accident and 'other' causes of brain death were more modestly but still significantly associated with graft failure. Grafts with an increased donor risk index have been preferentially transplanted into older candidates (>50 years of age) with moderate disease severity (nonstatus 1 with lower model for end-stage liver disease (MELD) scores) and without hepatitis C. Quantitative assessment of the risk of donor liver graft failure using a donor risk index is useful to inform the process of organ acceptance.
移植医生和候选者越来越意识到供体特征会显著影响肝移植的结果。虽然单个供体变量的定性影响已为人所知，但与特征组合相关的定量风险尚不清楚。利用1998年至2002年的全国数据，我们制定了一个供体风险定量指数。Cox回归模型确定了七个供体特征，这些特征独立预测移植失败风险显著增加。40岁以上（尤其是60岁以上）的供体年龄、心脏死亡后捐赠（DCD）和劈离/部分移植与移植失败密切相关，而非洲裔美国人种族、身高较低、脑血管意外和脑死亡的“其他”原因与移植失败的关联较小，但仍具有显著相关性。供体风险指数增加的移植物已被优先移植给年龄较大（>50岁）、疾病严重程度中等（非1级，终末期肝病模型（MELD）评分较低）且无丙型肝炎的候选者。使用供体风险指数对供体肝移植失败风险进行定量评估，有助于指导器官接受过程。
