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肝移植前后的住院模式。

Hospitalization patterns before and after liver transplantation.

作者信息

Schaubel Douglas E, Wei Guanghui, Dykstra Dawn M, Port Friedrich K, Merion Robert M

机构信息

Department of Biostatistics, Ann Arbor, MI 48109-2029, USA.

出版信息

Transplantation. 2007 Dec 27;84(12):1590-4. doi: 10.1097/01.tp.0000295733.69375.2f.

Abstract

BACKGROUND

Mortality among patients with chronic liver failure is significantly reduced upon liver transplantation. However, decreases in mortality may not be accompanied by decreases in morbidity metrics, such as hospitalization rates. We compared pre- and posttransplant hospitalization rates for liver transplant recipients.

METHODS

Statewide hospitalization data were analyzed among 215 adult chronic liver failure patients in Pennsylvania who received a deceased donor transplant from September 2001 to December 2002. Generalized estimating equation (GEE) models were fitted to compare covariate-adjusted pre- and posttransplant hospital admission rates and mean length of stay per admission. The study minimized biases by calculating pre- and posttransplant morbidity in a cohort restricted to patients who received a transplant and were compared to themselves.

RESULTS

Liver transplant recipients experienced a significant 70% reduction in hospitalization rates (P<0.0001) posttransplant versus pretransplant. The decline, which occurred for all Model for End-Stage Liver Disease (MELD) subgroups, was significant for patients transplanted at all MELD scores except 6-9. However, even patients with MELD 6-9 experienced a significant decrease in mean length of stay, post versus pretransplant. Higher MELD scores at transplant were generally associated with a greater reduction in hospitalization rates. Also, patients transplanted with lower MELD scores appeared to receive lower quality livers.

CONCLUSIONS

Our results indicate that the benefit of transplantation extends beyond patient survival and that an important reduction in hospitalization rates is experienced by transplanted patients. Further study is required to determine whether these results are generalizable to the entire United States and to evaluate the donor liver quality used for recipients of different MELD scores.

摘要

背景

肝移植可显著降低慢性肝衰竭患者的死亡率。然而,死亡率的降低可能并未伴随着诸如住院率等发病率指标的下降。我们比较了肝移植受者移植前后的住院率。

方法

分析了宾夕法尼亚州215例成年慢性肝衰竭患者的全州住院数据,这些患者于2001年9月至2002年12月接受了已故供体移植。采用广义估计方程(GEE)模型比较经协变量调整后的移植前后住院率及每次住院的平均住院时间。该研究通过在一个仅限于接受移植且自身进行比较的队列中计算移植前后的发病率,将偏差降至最低。

结果

与移植前相比,肝移植受者移植后的住院率显著降低了70%(P<0.0001)。所有终末期肝病模型(MELD)亚组均出现了这种下降,除MELD评分为6 - 9的患者外,所有MELD评分的患者移植后住院率的下降均具有统计学意义。然而,即使是MELD评分为6 - 9的患者,移植后平均住院时间也显著缩短。移植时较高的MELD评分通常与住院率的更大降幅相关。此外,接受较低MELD评分移植的患者似乎接受的供肝质量较低。

结论

我们的结果表明,移植的益处不仅限于患者生存,移植患者的住院率也有显著降低。需要进一步研究以确定这些结果是否适用于整个美国,并评估用于不同MELD评分受者的供肝质量。

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