Piscaglia Fabio, Camaggi Valeria, Ravaioli Matteo, Grazi Gian Luca, Zanello Matteo, Leoni Simona, Ballardini Giorgio, Cavrini Giulia, Pinna Antonio Daniele, Bolondi Luigi
Department of Internal Medicine and Gastroenterology, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Liver Transpl. 2007 Jun;13(6):857-66. doi: 10.1002/lt.21155.
The best prioritization of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation under the model for end-stage liver disease (MELD) allocation system is still being debated. We analyzed the impact of a MELD adjustment for HCC, which consisted of the addition of an extra score (based on the HCC stage and waiting time) to the native MELD score. The outcome was analyzed for 301 patients with chronic liver disease listed for liver transplantation between March 1, 2001 and February 28, 2003 [United Network for Organ Sharing (UNOS)-Child-Turcotte-Pugh (CTP) era, 163 patients, 28.8% with HCC] and between March 1, 2003 and February 28, 2004 (HCC-MELD era, 138 patients, 29.7% with HCC). In the HCC-MELD era, the cumulative dropout risk at 6 months was 17.6% for patients with HCC versus 22.3% for those patients without HCC (P = NS), similar to that in the UNOS-CTP era. The cumulative probability of transplantation at 6 months was 70.3% versus 39.0% (P = 0.005), being higher than that in the UNOS-CTP era for patients with HCC (P = 0.02). At the end of the HCC-MELD era, 12 patients with HCC (29.3%) versus 57 without HCC (58.8%) were still on the list (P = 0.001). Both native and adjusted MELD scores were higher (P < 0.05) and progressed more in patients with HCC who dropped out than in those who underwent transplantation or remained on the list (the initial-final native MELD scores were 17.3-23.1, 15.5-15.6, and 12.8-14.1, respectively). The patients without HCC remaining on the list showed stable MELD scores (initial-final: 15.1-15.4). In conclusion, the present data support the strategy of including the native MELD scores in the allocation system for HCC. This model allows the timely transplantation of patients with HCC without severely affecting the outcome of patients without HCC.
在终末期肝病模型（MELD）分配系统下，肝细胞癌（HCC）患者等待肝移植的最佳优先排序仍存在争议。我们分析了针对HCC的MELD调整的影响，该调整包括在原始MELD评分基础上增加一个额外分数（基于HCC分期和等待时间）。对2001年3月1日至2003年2月28日期间（器官共享联合网络（UNOS）-Child-Turcotte-Pugh（CTP）时代，163例患者，28.8%为HCC患者）以及2003年3月1日至2004年2月28日期间（HCC-MELD时代，138例患者，29.7%为HCC患者）登记等待肝移植的301例慢性肝病患者的结果进行了分析。在HCC-MELD时代，HCC患者6个月时的累积退出风险为17.6%，无HCC患者为22.3%（P=无显著差异），与UNOS-CTP时代相似。HCC患者6个月时的累积移植概率为70.3%，无HCC患者为39.0%（P=0.005），高于UNOS-CTP时代的HCC患者（P=0.02）。在HCC-MELD时代结束时，仍在等待名单上的HCC患者有12例（29.3%），无HCC患者有57例（58.8%）（P=0.001）。退出的HCC患者的原始和调整后的MELD评分均更高（P<0.05），且进展程度大于接受移植或仍在等待名单上的患者（初始-最终原始MELD评分分别为17.3 - 23.1、15.5 - 15.6和12.8 - 14.1）。仍在等待名单上的无HCC患者的MELD评分稳定（初始-最终：15.1 - 15.4）。总之，目前的数据支持将原始MELD评分纳入HCC分配系统的策略。该模型允许HCC患者及时接受移植，而不会严重影响无HCC患者的结果。
