Middleton S J, Nishida S, Tzakis A, Woodward J M, Duncan S, Watson C J, Wiles A, Sivaprakasam R, Butler A J, Gabe S M, Jamieson N V
Department of Gastroenterology, Addenbrooke's, Cambridge University Teaching Hospital, UK.
Transplant Proc. 2010 Jan-Feb;42(1):19-21. doi: 10.1016/j.transproceed.2009.12.022.
Preoperative quantification of survival after transplantation would assist in assessing patients. We have developed a preliminary preoperative scoring system, called the Cambridge-Miami (CaMi) score, for transplantation of the small intestine either alone or as a composite graft.
The score combines putative risk factors for early-, medium-, and long-term survival. Factors included were loss of venous access and impairment of organs or systems not corrected by transplantation. Each factor was scored 0-3. A score of 3 indicated comorbidity approaching a contraindication for transplantation, that which might lead to but was not currently an adverse risk factor scored 1, and that presenting a definite but moderate increase in risk scored 2. The preoperative scores of 20 patients who had received intestinal transplants either isolated or as part of a cluster graft, who had either been followed up postoperatively for at least 10 years, or died within 10 years were compared with their survivals.
Postoperative survival and CaMi score inversely correlated when analysed using Spearman test (r(s) = -0.82; P = .0001). A score of <3 associated with survival > or =3 years (12/12 patients) and >3 with survival of <6 months (4/4). Patient Kaplan-Meier (KM) survival curves for patients grouped according to CaMi score became significantly different from group 0 to group 3. Using this as a threshold score patients grouped as either >2 or <3 had significantly different survival rates (log-rank; P = .0001), KM median survival hazard ratio (HR) = 6, and rate of death KM HR = 5. Receiver-operator characteristics indicate a high degree of accuracy for prediction of death with an area under the curve (C statistic) at 3 years of 0.98, at 5 years of 0.82, and at 10 years of 0.65.
This initial validation suggested that the preoperative CaMi score predicted postoperative survival.
移植术后生存情况的术前量化有助于评估患者。我们已经开发了一种初步的术前评分系统，称为剑桥-迈阿密（CaMi）评分，用于单独小肠移植或作为复合移植物的小肠移植。
该评分结合了早期、中期和长期生存的假定风险因素。包括的因素有静脉通路丧失以及未通过移植纠正的器官或系统损害。每个因素的评分为0至3分。3分表示合并症接近移植禁忌证，可能导致但目前不是不良风险因素的评分为1分，而显示风险有明确但适度增加的评分为2分。将20例接受了孤立小肠移植或作为集群移植物一部分的小肠移植患者的术前评分与其生存情况进行比较，这些患者术后随访至少10年或在10年内死亡。
使用Spearman检验分析时，术后生存与CaMi评分呈负相关（r(s)= -0.82；P = 0.0001）。评分<3分与生存≥3年相关（12/12例患者），评分>3分与生存<6个月相关（4/4例）。根据CaMi评分分组的患者的Kaplan-Meier（KM）生存曲线从0组到3组有显著差异。以此阈值评分，分为>2分或<3分的患者有显著不同的生存率（对数秩检验；P = 0.0001），KM中位生存风险比（HR）= 6，死亡KM HR率 = 5。受试者工作特征曲线表明，预测死亡的准确性较高，3年时曲线下面积（C统计量）为0.98，5年时为0.82，10年时为0.65。
这一初步验证表明，术前CaMi评分可预测术后生存情况。
