Charpentier Kevin P, Mavanur Arun
Rhode Island Hospital, Department of Surgery, Division of Transplant Surgery, Providence, RI 02903, USA.
Liver Transpl. 2008 Mar;14(3):303-7. doi: 10.1002/lt.21353.
Guidelines are in place regarding who is a candidate for liver transplantation. Once a potential candidate is listed, there are no uniform guidelines indicating when he should be removed from the list because of a change in clinical status. A survey with 14 scenarios was sent to the medical and surgical directors of all liver transplant programs in the United States. In each scenario, clinical information was provided about a patient active on the transplant wait list. Data regarding a clinical change were provided, and responders were questioned whether they would remove the patient from the wait list. The scenarios were designed to address the issues of age, etiology of liver disease, renal dysfunction, respiratory failure, infection, failure to thrive, and social support. Two hundred four questionnaires were mailed with 47 responses (23%): 8 return to sender, 24 surgeons, and 15 hepatologists. All 11 United Network for Organ Sharing regions were represented. The responders were well distributed among university programs (n = 28), private practice programs (n = 10), and health maintenance organization programs (n = 1). Nine responses were from small-volume programs (< or =25 transplants), 12 were from medium-volume programs (26-50 transplants), and 18 were from large-volume programs (> or =51 transplants). There was wide variability between responders regarding which patients should be removed from the transplant wait list. Patient age and etiology of liver disease led to the greatest discordance among responders. In conclusion, there is a lack of agreement and standardization among US liver transplant programs regarding who should be removed from the wait list for a change in clinical status.
关于谁是肝移植候选人已有相关指南。一旦潜在候选人被列入名单，却没有统一的指南说明由于临床状况变化何时应将其从名单中移除。一项包含14种情形的调查被发送给美国所有肝移植项目的内科和外科主任。在每种情形中，都提供了关于一名活跃在移植等候名单上患者的临床信息。给出了关于临床变化的数据，并询问受访者是否会将该患者从等候名单中移除。这些情形旨在解决年龄、肝病病因、肾功能不全、呼吸衰竭、感染、生长发育不良以及社会支持等问题。共邮寄了204份问卷，收到47份回复（23%）：8份退回，24份来自外科医生，15份来自肝病专家。器官共享联合网络的所有11个地区都有代表。受访者在大学项目（n = 28）、私人执业项目（n = 10）和健康维护组织项目（n = 1）中分布良好。9份回复来自小容量项目（≤25例移植），12份来自中等容量项目（26 - 50例移植），18份来自大容量项目（≥51例移植）。在哪些患者应从移植等候名单中移除的问题上，受访者之间存在很大差异。患者年龄和肝病病因导致受访者之间的分歧最大。总之，在美国肝移植项目中，对于因临床状况变化谁应从等候名单中移除，缺乏共识和标准化。
