Maluf Daniel G, Edwards Erick B, Stravitz R Todd, Kauffman H Myron
Division of Transplantation Surgery, Virginia Commonwealth University, Richmond, VA 23298-0248, USA.
Liver Transpl. 2009 Jun;15(6):592-9. doi: 10.1002/lt.21699.
We have investigated the impact of the donor risk index (DRI) on the outcome of hepatitis C virus (HCV)-infected patients undergoing liver transplantation (LTx). Retrospective analysis was performed from the Organ Procurement and Transplantation Network database (January 1, 2000 to June, 2006). The DRI was calculated as described by Feng et al. (Am J Transplant 2006;6:783-790). Model for End-Stage Liver Disease (MELD) exceptions were excluded from the analysis. Relative risk (RR) estimates of patient and graft loss were derived from Cox regression models. The Wald test was used to test the effect of the MELD score at transplant on the HCV-DRI interaction. Of the LTx recipients (16,678), 76.1% were Caucasian, and 66.7% were male; the median age was 52 (range, 18-80 years), and the mean follow-up time was 1148 days (range, 0-2959 days). Forty-six percent (n = 7675) of LTx recipients were HCV(+). The median DRI was 1.3 (range, 0.77-4.27). Increasing DRI was associated with a statistically significant increase in the RR of graft failure and patient death for both HCV(+) and HCV(-) recipients. However, HCV(+) recipients demonstrated a significantly higher increase in the RR of patient and graft loss as a function of the DRI than HCV(-) subjects, even after adjustments for several recipient factors, including MELD. In conclusion, a synergistic interaction between donor DRI and recipient HCV status exists, such that an allograft from a high-DRI donor more adversely affects the outcome of an HCV(+) recipient than that of an HCV(-) recipient.
我们研究了供体风险指数（DRI）对接受肝移植（LTx）的丙型肝炎病毒（HCV）感染患者预后的影响。从器官获取与移植网络数据库（2000年1月1日至2006年6月）进行回顾性分析。按照Feng等人所述方法计算DRI（《美国移植杂志》2006年；6：783 - 790）。分析排除了终末期肝病模型（MELD）例外情况。患者和移植物丢失的相对风险（RR）估计值来自Cox回归模型。采用Wald检验来检验移植时MELD评分对HCV - DRI相互作用的影响。在LTx受者（16,678例）中，76.1%为白种人，66.7%为男性；中位年龄为52岁（范围18 - 80岁），平均随访时间为1148天（范围0 - 2959天）。46%（n = 7675）的LTx受者HCV呈阳性。DRI中位数为1.3（范围0.77 - 4.27）。对于HCV阳性和HCV阴性受者，DRI升高均与移植物失败和患者死亡的RR在统计学上显著增加相关。然而，即使在对包括MELD在内的多个受者因素进行调整后，HCV阳性受者的患者和移植物丢失RR随DRI的增加幅度仍显著高于HCV阴性受者。总之，供体DRI与受者HCV状态之间存在协同相互作用，即来自高DRI供体的同种异体移植物对HCV阳性受者预后的不利影响比对HCV阴性受者更大。
