McDiarmid Sue V, Goodrich Nathan P, Harper Ann M, Merion Robert M
Department of Pediatrics and Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
Liver Transpl. 2007 May;13(5):699-707. doi: 10.1002/lt.21125.
Status 1 is the listing category reserved for patients awaiting liver transplantation who are at risk of imminent death. This high allocation priority was intended to benefit patients with acute liver failure and children with severe chronic liver failure. However, the status 1 criteria were not well defined. The aims of this study, which used the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients database for patients wait-listed between February 27, 2002, and September 30, 2003, were to determine the indication and numbers of children and adults at status 1 (including regional variations); examine death rates on the waiting list for children at vs. not at status 1; and examine time to death, transplant, or removal from the waiting list for both pediatric and adult status 1 candidates. During the study period, 40.3% of children and 6.1% of adults were transplanted at status 1. The indication was acute liver failure in 52.1% of adults and 31% of children. Among status 1 transplants, Regional Review Board exceptions were granted for 16.7% of children and 10.1% of adults. Death rates for children listed at status 1 by exception per patient-year at risk were substantially lower (0.51) than those of children with acute liver failure (4.06) or with chronic liver disease and Pediatric End-Stage Liver Disease score > or =25 (4.63). The percentage of adults who died while on the waiting list within 90 days of listing was more than twice that of children, whereas the percentages transplanted were similar. Patients listed and transplanted at status 1 were a heterogeneous population with an overrepresentation of children with varying degrees of chronic liver disease and other exceptions, and an associated wide variation in waiting list mortality. Recent changes in status 1 criteria provide stricter definitions, particularly for children, including the removal of the "by exception" category, with the intent that all candidates listed at status 1 share a similar mortality risk.
状态1是为等待肝移植且有即将死亡风险的患者保留的列表类别。这种高分配优先级旨在使急性肝衰竭患者和严重慢性肝衰竭儿童受益。然而，状态1的标准并未明确界定。本研究利用器官获取与移植网络/移植受者科学登记数据库，针对2002年2月27日至2003年9月30日期间列入等待名单的患者，旨在确定处于状态1的儿童和成人的适应症及人数（包括地区差异）；检查处于状态1与未处于状态1的儿童在等待名单上的死亡率；并检查儿科和成人状态1候选者的死亡时间、移植时间或从等待名单中移除的时间。在研究期间，40.3%的儿童和6.1%的成人在状态1时接受了移植。适应症方面，52.1%的成人和31%的儿童为急性肝衰竭。在状态1的移植中，16.7%的儿童和10.1%的成人获得了地区审查委员会的例外批准。按每患者年风险计算，因例外而处于状态1的儿童的死亡率（0.51）显著低于急性肝衰竭儿童（4.06）或慢性肝病且儿科终末期肝病评分≥25的儿童（4.63）。列入等待名单后90天内等待名单上死亡的成人百分比是儿童的两倍多，而移植的百分比相似。列入状态1并接受移植的患者是一个异质群体，不同程度慢性肝病儿童和其他例外情况的比例过高，且等待名单死亡率存在广泛差异。状态1标准最近的变化提供了更严格的定义，特别是对儿童而言，包括取消“例外”类别，目的是使所有列入状态1的候选者具有相似的死亡风险。
