Shiffman M L, Saab S, Feng S, Abecassis M I, Tzakis A G, Goodrich N P, Schaubel D E
Hepatology Section and Liver Transplant Program, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
Am J Transplant. 2006;6(5 Pt 2):1170-87. doi: 10.1111/j.1600-6143.2006.01273.x.
Three years of survival data are now available and the impact of the model for end-stage liver disease (MELD) allocation system is becoming clear. After a decline in new registrants to the waiting list in 2002, the number increased to 10 856 new patients in 2004. Since the implementation of MELD, the percentage of patients who have been on the list for 1-2 years has declined from 24% to 19%. There has been a shift upward in the percentage of patients with higher MELD scores on the waiting list. An increasing percentage of adult living donor liver recipients are over the age of 50 years; from 1% in 1997 to 51% in 2004. Parents donating to children (93% of living donors in 1995), represented only 14% in 2004. Long-term adjusted patient survival declined with increasing recipient age in adults following either DDLT or LDLT. Cirrhosis caused by chronic hepatitis C virus (HCV) is the leading indication for liver transplantation and is associated with reduced long-term survival in recipients with HCV compared to those without HCV, 68% at 5 years compared to 76%. Although the intestine waiting list has more than doubled over the last decade, an increasing number of centers now perform intestinal transplantation with greater success.
现已获得三年的生存数据，终末期肝病模型（MELD）分配系统的影响正逐渐明晰。2002年等待名单上的新登记人数有所下降后，2004年新患者人数增至10856人。自MELD实施以来，在名单上等待1至2年的患者比例已从24%降至19%。等待名单上MELD评分较高的患者比例呈上升趋势。接受成人活体供肝移植的患者中，50岁以上者的比例不断增加，从1997年的1%升至2004年的51%。父母捐肝给子女的情况（1995年活体供者的93%），在2004年仅占14%。在接受尸体供肝肝移植（DDLT）或活体供肝肝移植（LDLT）后的成人中，患者的长期校正生存率随受者年龄增加而下降。慢性丙型肝炎病毒（HCV）导致的肝硬化是肝移植的主要适应证，与无HCV的受者相比，HCV受者的长期生存率降低，5年生存率分别为68%和76%。尽管在过去十年中，肠道移植等待名单增加了一倍多，但现在越来越多的中心开展肠道移植并取得了更大的成功。
