终末期肝病模型（MELD）系统用于肝脏分配与共享：两个意大利中心的经验

Model for End-Stage Liver Disease (MELD) system to allocate and to share livers: experience of two Italian centers.

作者信息

Ravaioli M, Masetti M, Dazzi A, Romano A, Spaggiari M, Grazi G L, Ercolani G, Cescon M, Di Gioia P, De Ruvo N, Montalti R, Ballarin R, Di Benedetto F, Ridolfi L, Alvaro N, Ramacciato G, Morelli C, Gerunda E, Pinna A D

机构信息

Department of Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

出版信息

Transplant Proc. 2008 Jul-Aug;40(6):1814-5. doi: 10.1016/j.transproceed.2008.05.053.

DOI:10.1016/j.transproceed.2008.05.053

PMID:18675057

Abstract

BACKGROUND

The use of the Model for End-stage Liver Disease (MELD) score to prioritize patients on liver waiting lists and to share organs among centers was effective according to US data, but few reports are available in Europe.

MATERIALS AND METHODS

We evaluated the outcome of 887 patients listed between April 2004 and July 2006 in a common list by two transplant centers (University of Bologna [BO] and University of Modena [MO] ordered according to the MELD system. Patients with hepatocellular carcinoma had a score calculated according to their real MELD, tumor stage, and waiting time.

RESULTS

Five hundred eighty-six (67%) patients were listed from BO and 291 (33%) from MO. The clinical features of recipients (sex, age, blood group, and real MELD) were comparable between centers. The number of liver transplantations performed was 307, and 273 (89%) recipients had a calculated MELD >or=20. Liver transplantations were equally distributed according to the number of patients listed: 215 out of 586 (36.7%) for BO and 92 out of 291 (31.6%) for MO. The median real MELD of patients transplanted was 20, and 246 out of 307 (80.1%) grafts transplanted were functioning. The dropouts from the list were 124 (14%), and 87 (70%) of these patients had a calculated MELD >or=20.

CONCLUSION

The MELD system was effective to share livers among the two Italian centers. According to this policy, livers were allocated to the recipients with the highest probability of dropout and who had a satisfactory survival after liver transplantation.

摘要

背景

根据美国的数据，使用终末期肝病模型（MELD）评分对肝脏等待名单上的患者进行优先级排序并在各中心之间共享器官是有效的，但欧洲的相关报道较少。

材料与方法

我们评估了2004年4月至2006年7月期间在一个共同名单上登记的887例患者的结局，该名单由两个移植中心（博洛尼亚大学[BO]和摩德纳大学[MO]）根据MELD系统排序。肝细胞癌患者的评分根据其实际MELD、肿瘤分期和等待时间计算得出。

结果

586例（67%）患者来自BO，291例（33%）来自MO。各中心受者的临床特征（性别、年龄、血型和实际MELD）具有可比性。进行的肝移植数量为307例，273例（89%）受者的计算MELD≥20。肝移植根据登记患者数量平均分配：BO的586例中有215例（36.7%），MO的291例中有92例（31.6%）。移植患者的实际MELD中位数为20，307例移植的移植物中有246例（80.1%）功能良好。名单上的退出者有124例（14%），其中87例（70%）患者的计算MELD≥20。