Barone Michele, Avolio Alfonso W, Di Leo Alfredo, Burra Patrizia, Francavilla Antonio
Section of Gastroenterology, D.E.T.O., University of Bari, Piazza G. Cesare, Bari, Italy.
Transplantation. 2008 Mar 27;85(6):844-9. doi: 10.1097/TP.0b013e318166cc38.
Blood group O candidates remain on the waiting list for a liver transplant for a longer time than candidates of other blood groups. Herein, we analyzed potential factors affecting waiting times in the period that preceded the introduction of the model for end-stage liver disease (MELD) and in MELD era, remarking possible corrections introduced by the adoption of the MELD.
Our analysis was entirely based on data obtained from the "Organ Procurement and Transplantation Network", referring to the periods before and after the adoption of the MELD.
In the MELD era, taking into consideration all candidates, the cumulative probability of remaining on the waiting list significantly diminished whereas that of undergoing transplantation significantly increased when compared with the pre-MELD era. However, group O candidates maintained the lowest cumulative probability of undergoing liver transplant, in all MELD classes, and the highest percentage of list removal for death/too sick. What caused the highest disadvantage for group O, in both eras, was the use of group O organs for ABO-compatible transplants, even in the absence of urgency. In candidates receiving ABO-compatible organs a significantly lower graft survival rate was observed compared with candidates receiving ABO-identical organs, even when the analysis was adjusted for the MELD score.
The introduction of the MELD significantly reduced the waiting time for all candidates as also the shift of group O organs. Limiting ABO-compatible organs exclusively to urgent cases would have a positive effect not only in terms of individual justice, but also terms of in general utility, considering the effect of ABO-matching on graft survival.
O型血的肝脏移植候选者在等待名单上的时间比其他血型的候选者更长。在此，我们分析了在终末期肝病模型（MELD）引入之前及MELD时代影响等待时间的潜在因素，并指出采用MELD可能带来的修正。
我们的分析完全基于从“器官获取与移植网络”获得的数据，涉及采用MELD之前和之后的时期。
在MELD时代，考虑所有候选者，与MELD时代之前相比，留在等待名单上的累积概率显著降低，而接受移植的概率显著增加。然而，在所有MELD分级中，O型血候选者接受肝脏移植的累积概率最低，因死亡/病情过重而从名单上移除的比例最高。在两个时代，导致O型血候选者处于最不利地位的原因是，即使不紧急，O型血器官也用于ABO血型相容的移植。在接受ABO血型相容器官的候选者中，观察到的移植物存活率显著低于接受ABO血型相同器官的候选者，即使在根据MELD评分进行调整的分析中也是如此。
MELD的引入显著缩短了所有候选者的等待时间以及O型血器官的转移。将ABO血型相容器官仅用于紧急情况不仅在个体公平方面，而且从总体效用角度考虑ABO血型匹配对移植物存活的影响，都将产生积极效果。
