Perut Valérie, Conti Filoména, Scatton Olivier, Soubrane Olivier, Calmus Yvon, Vidal-Trecan Gwenaëlle
Unité de Gestion des Risques et Qualité, Groupe hospitalier Cochin-Saint Vincent de Paul, AP-HP, Paris, France.
J Hepatol. 2009 Oct;51(4):707-14. doi: 10.1016/j.jhep.2009.04.018. Epub 2009 May 28.
BACKGROUND/AIMS: In France, the most common cause of cirrhosis is excessive alcohol consumption. Post-transplant survival rates in patients with alcoholic liver disease (ALD) are at least as good as those seen with other indications. However, fewer of these patients are found on the waiting list. To understand the reasons for this discrepancy, it was decided to examine physicians' attitudes concerning the allocation of deceased donor liver allografts.
Using a standardized postal questionnaire, 1739 physicians were asked to allocate 100 liver transplants to two competing groups of patients who were equivalent except for the cause of their cirrhosis (i.e. alcohol-related or primary biliary cirrhosis). A composite score was then used to assess their attitude regarding the behavior of alcoholics and their responsibility for their illness.
Among the 475 respondents (response rate: 27.3%), 55.2% allocated fewer than 50 transplants to ALD patients. This lower rate was independently associated with factors such as being a general practitioner (odds ratio [OR]=3.2, 95% confidence interval [95%CI]=1.8-5.9), a misinterpretation of ALD patients being equivalent to others (OR=1.8, 95%CI=1.1-3.0) or unfavorable attitudes regarding alcoholics (OR=4.0, 95%CI=1.7-9.5, to OR=126.8, 95%CI=34.0-472.1).
Greater information and education of physicians may improve access to liver transplantation for ALD patients.
背景/目的：在法国，肝硬化最常见的病因是过度饮酒。酒精性肝病（ALD）患者移植后的生存率至少与其他适应症患者相当。然而，等待名单上这类患者较少。为了解这种差异的原因，决定调查医生对已故供体肝脏移植分配的态度。
通过标准化邮政问卷，要求1739名医生将100例肝移植分配给两组相互竞争的患者，这两组患者除肝硬化病因（即酒精相关性或原发性胆汁性肝硬化）外其他情况相同。然后使用综合评分来评估他们对酗酒者行为及其疾病责任的态度。
在475名受访者中（回复率：27.3%），55.2%给ALD患者分配的移植例数少于50例。这种较低的分配率与以下因素独立相关，如作为全科医生（优势比[OR]=3.2，95%置信区间[95%CI]=1.8 - 5.9）、误解ALD患者与其他患者相同（OR=1.8，95%CI=1.1 - 3.0）或对酗酒者持不利态度（OR=4.0，95%CI=1.7 - 9.5至OR=126.8，95%CI=34.0 - 472.1）。
加强对医生的信息提供和教育可能会改善ALD患者获得肝移植的机会。
