Barshes N R, Horwitz I B, Franzini L, Vierling J M, Goss J A
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Am J Transplant. 2007 May;7(5):1265-70. doi: 10.1111/j.1600-6143.2007.01758.x. Epub 2007 Mar 12.
Extended criteria donor (ECD) liver allografts are often allocated to less severely ill liver transplant (LT) candidates who are at a relatively lower risk of pretransplant mortality, but it is not clear that the use of ECD allografts will decrease center waitlist mortality (WLM). Individual patient data from the UNOS OPTN database (2002-2005) were aggregated to obtain center-specific data. Deceased donor allografts with any of the following characteristics were defined as ECDs: from a donor with any of the criteria described by the New York State Department of Health Workgroup; or 12+ h of cold ischemia. Multivariate regression was used to examine the relationship between WLM and ECD, non-ECD and LDLT use after adjusting for candidate severity of illness. A total of 3555 ECD transplants, 11,660 standard criteria donor (SCD) transplants, and 717 LDLTs were performed at 100 centers during this period. The model demonstrated that SCD and ECD LTs were inversely correlated with a center's WLM (beta=-0.242 and -0.221, respectively; p <or= 0.003 for each). LDLTs did not significantly reduce WLM (beta=-0.048, p=0.55). In summary, increasing ECD liver allograft use significantly decreased WLM at US centers. Policies encouraging the increase used of ECDs would further reduce WLM.
边缘供体（ECD）肝脏移植器官通常分配给病情较轻、移植前死亡风险相对较低的肝移植（LT）受者，但使用ECD移植器官是否会降低中心等待名单死亡率（WLM）尚不清楚。汇总了来自器官共享联合网络（UNOS）OPTN数据库（2002 - 2005年）的个体患者数据以获取中心特异性数据。具有以下任何特征的已故供体移植器官被定义为ECD：来自符合纽约州卫生部工作组所描述任何标准的供体；或冷缺血时间达12小时及以上。在对候选者疾病严重程度进行校正后，使用多变量回归分析来研究WLM与ECD、非ECD及活体肝移植（LDLT）使用之间的关系。在此期间，100个中心共进行了3555例ECD移植、11660例标准供体（SCD）移植和717例LDLT。该模型表明，SCD和ECD肝移植与中心的WLM呈负相关（β分别为 - 0.242和 - 0.221；两者p均≤0.003）。LDLT并未显著降低WLM（β = - 0.048，p = 0.55）。总之，在美国各中心，增加ECD肝脏移植器官的使用显著降低了WLM。鼓励增加ECD使用的政策将进一步降低WLM。
