Chungfat Neil, Dixler Irma, Cohran Valeria, Buchman Alan, Abecassis Michael, Fryer Jonathan
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
J Am Coll Surg. 2007 Dec;205(6):755-61. doi: 10.1016/j.jamcollsurg.2007.06.299. Epub 2007 Sep 20.
United Network for Organ Sharing (UNOS) reports indicate that waiting list mortality for intestinal transplant candidates greatly exceeds that for all other organ transplant candidates. But United Network for Organ Sharing outcomes reports have not routinely distinguished between the intestine candidate subgroups that are listed only for an intestine and those that are also listed for a liver.
Data were obtained by request from the collaborative Organ Procurement and Transplantation Network (United Network for Organ Sharing)/Scientific Registry of Transplant Recipients (University Research and Education Association) database. Waiting list data for intestinal transplant recipients from 1995 to 2004 were divided into those candidates listed for only an intestine and those listed for both an intestine and a liver. Additional data concerning overall waiting list outcomes and posttransplant survival rates stratified into pediatric and adult subsets were also obtained and analyzed.
The overall number of candidates on the intestinal transplant waiting list has increased steadily since 1995 and, consistently, the majority of candidates have also been listed for a liver. This subset was found to have both a higher relative risk of dying while awaiting transplantation and lower relative odds of receiving transplants. In addition, parenteral nutrition-associated liver disease is a major problem across all age groups, as evidenced by the combined liver and intestine listings that compose the majority of both adult and pediatric waiting list populations. Posttransplant survival data were found to be superior for isolated intestine recipients compared with liver-intestine recipients.
The preponderance of dual listings and their associated inferior outcomes, before and after transplantation, has skewed overall intestinal transplant outcomes. Because progression of parenteral nutrition-associated liver disease can be insidious, and recognition of irreversibility is often difficult, intestine-only transplants should be considered early for high-risk patients before parenteral nutrition-associated liver disease progression mandates inclusion of a liver graft also.
器官共享联合网络（UNOS）的报告表明，肠移植候选者的等待名单死亡率大大超过所有其他器官移植候选者。但器官共享联合网络的结果报告并未常规区分仅为肠移植列出的候选者亚组和也为肝移植列出的候选者亚组。
通过向协作的器官获取与移植网络（器官共享联合网络）/移植受者科学注册中心（大学研究与教育协会）数据库申请获取数据。1995年至2004年肠移植受者的等待名单数据被分为仅为肠移植列出的候选者和为肠移植及肝移植列出的候选者。还获取并分析了有关总体等待名单结果以及分层为儿科和成人亚组的移植后生存率的其他数据。
自1995年以来，肠移植等待名单上的候选者总数稳步增加，并且一直以来，大多数候选者也被列为肝移植候选者。发现这一亚组在等待移植期间死亡的相对风险更高，而接受移植的相对几率更低。此外，肠外营养相关肝病在所有年龄组中都是一个主要问题，这在构成成人和儿科等待名单人群大多数的肝肠联合移植名单中得到了证明。发现孤立性肠移植受者的移植后生存数据优于肝肠联合移植受者。
双重列出及其相关的较差移植前后结果占优势，使总体肠移植结果产生偏差。由于肠外营养相关肝病的进展可能很隐匿，而且往往难以认识到其不可逆性，对于高危患者，在肠外营养相关肝病进展要求同时移植肝脏之前，应尽早考虑仅进行肠移植。
