Santori G, Andorno E, Morelli N, Casaccia M, Bottino G, Ghirelli R, Valente U
Department of Transplantation, San Martino University Hospital, Genoa, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1903-5. doi: 10.1016/j.transproceed.2008.05.016.
Since February 2002, the United Network for Organ Sharing (UNOS) proposed to adopt a modified version of the Model for End-Stage Liver Disease (MELD) to assign priority on the waiting list for orthotopic liver transplantation (OLT). In this study, we evaluated the impact of MELD score on liver allocation in a single center series of 198 liver recipients (mean age of patients, 52.21+/-8.92 years), considering the relationship between clinical urgency derived from MELD score (overall MELD, 18.7+/-6.83; MELD <15 in 69 patients, MELD >or=15 in 129 patients) and geographical distribution of cadaveric donors (inside/outside Liguria Region, 125/73). The waiting time for OLT was 230+/-248 days, whereas the 3-month and 1-year patient survivals were 87.37% and 79.79%, respectively. No difference was observed for MELD score retrospectively calculated for patients who underwent OLT before February 2002 (n=71) compared with MELD score calculated for patients who received a liver thereafter (18.26+/-6.68 vs 18.94+/-6.92; P= .504). No significant difference was found in waiting time before and after adoption of MELD score (213+/-183 vs 238+/-278 days; P= .500), or by stratifying patients for MELD <15/>or=15 (225+/-234 vs 232+/-256 days; P= .851). Using the geographical distribution of donors as a grouping variable (outside vs inside Liguria Region), no significance occurred for MELD score (19.68+/-7.42 vs 18.17+/-6.42; P= .135) or waiting time (211+/-226 vs 242+/-261 days; P= .394). In our series, more OLTs were performed among sicker patients and no differences were found in the management of livers procured from cadaveric donors outside or inside Liguria Region. However, further efforts are needed to reduce the waiting time among patients with higher MELD scores.
自2002年2月起，器官共享联合网络（UNOS）提议采用终末期肝病模型（MELD）的修订版来确定原位肝移植（OLT）等待名单上的优先顺序。在本研究中，我们评估了MELD评分对198例肝移植受者（患者平均年龄52.21±8.92岁）单中心系列中肝脏分配的影响，同时考虑了MELD评分所反映的临床紧迫性（总体MELD评分18.7±6.83；69例患者MELD<15，129例患者MELD≥15）与尸体供者的地理分布（利古里亚地区内/外，125/73）之间的关系。OLT的等待时间为230±248天，而3个月和1年的患者生存率分别为87.37%和79.79%。2002年2月前接受OLT的患者（n = 71）回顾性计算的MELD评分与之后接受肝脏移植患者的MELD评分相比，未观察到差异（18.26±6.68 vs 18.94±6.92；P = 0.504）。采用MELD评分前后的等待时间无显著差异（213±183 vs 238±278天；P = 0.500），按MELD<15/≥15对患者进行分层时也无差异（225±234 vs 232±256天；P = 0.851）。以供者的地理分布作为分组变量（利古里亚地区外/内），MELD评分（19.68±7.42 vs 18.17±6.42；P = 0.135）或等待时间（211±226 vs 242±261天；P = 0.394）均无显著性差异。在我们的系列研究中，病情较重的患者接受OLT的更多，且在处理利古里亚地区外或内尸体供者的肝脏方面未发现差异。然而，仍需进一步努力以缩短MELD评分较高患者的等待时间。
