van der Meulen Jan H P, Lewsey Jim D, Dawwas Muhammad F, Copley Lynn P
Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Transplantation. 2007 Sep 15;84(5):572-9. doi: 10.1097/01.tp.0000280540.76370.37.
The UK and Ireland Liver Transplant Audit collects information on all liver transplantations that are carried out in both countries. In this paper, we describe these transplantations and their outcomes in adult patients according to primary liver disease diagnosis, type of transplantation and period.
A prospective cohort study of 7906 orthotopic liver transplantations carried out between April 1994 and June 2005 in the United Kingdom and Ireland. Multivariable logistic regression was used to investigate improvements in mortality according to period of transplantation adjusted for recipient and donor characteristics.
A total of 6,850 transplantations were done in adults (patients 16 years or older). Of these, 836 (12.2%) were first super-urgent procedures (33.7% men; median age 36 years), and 5,072 (74.0%) first elective procedures (60.0% men; median age 52 years). The percentage of patients who received a donor organ with abnormal appearance gradually increased, especially in patients receiving an elective transplant. Mortality at 90 days after first super-urgent transplant decreased from 29.6% (95% confidence interval: 23.5% to 36.9%) before October 1, 1996 to 16.0% (11.7% to 21.7%) after October 1, 2002. Considering the same time periods, mortality at 90 days after first elective transplant decreased from 10.6% (8.9% to 12.7%) to 7.7% (6.3% to 9.3%). Multivariable analysis demonstrated that these improvements cannot be explained by changes in the risk profile of recipients and donors.
Patients undergoing a liver transplantation in the most recent years had a better survival than patients with similar characteristics transplanted 10 years earlier. Posttransplant survival has improved despite a deteriorating quality of donor organs.
英国和爱尔兰肝脏移植审计收集了两国所有肝脏移植的信息。在本文中，我们根据原发性肝病诊断、移植类型和时间段，描述了成年患者的这些移植情况及其结果。
对1994年4月至2005年6月在英国和爱尔兰进行的7906例原位肝脏移植进行前瞻性队列研究。使用多变量逻辑回归分析，根据移植时间段，并对受者和供者特征进行调整，来研究死亡率的改善情况。
共对6850例成年人（16岁及以上患者）进行了移植。其中，836例（12.2%）为首次超紧急手术（男性占33.7%；中位年龄36岁），5072例（74.0%）为首次择期手术（男性占60.0%；中位年龄52岁）。接受外观异常供体器官的患者比例逐渐增加，尤其是接受择期移植的患者。首次超紧急移植后90天的死亡率从1996年10月1日前的29.6%（95%置信区间：23.5%至36.9%）降至2002年10月1日后的16.0%（11.7%至21.7%）。在相同时间段内，首次择期移植后90天的死亡率从10.6%（8.9%至12.7%）降至7.7%（6.3%至9.3%）。多变量分析表明，这些改善不能用受者和供者风险特征的变化来解释。
近年来接受肝脏移植的患者比10年前具有相似特征的移植患者有更好的生存率。尽管供体器官质量下降，但移植后的生存率仍有所提高。
