Benckert Christoph, Quante Markus, Thelen Armin, Bartels Michael, Laudi Sven, Berg Thomas, Kaisers Udo, Jonas Sven
Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Universitätsklinikum Leipzig, Leipzig, Germany.
Scand J Gastroenterol. 2011 Jul;46(7-8):941-8. doi: 10.3109/00365521.2011.568521. Epub 2011 Mar 28.
On 16 December 2006, most Eurotransplant countries changed waiting time oriented liver allocation policy to the urgency oriented Model for End-stage Liver Disease (MELD) system. There are limited data on the effects of this policy change within the Eurotransplant community.
A total of 154 patients who had undergone deceased donor liver transplantation (LT) were retrospectively analyzed in three time periods: period A (1-year pre-MELD, n = 42) versus period B (1-year post-MELD, n = 52) versus period C (2 years after MELD implementation, n = 60).
The median MELD score at the time of LT increased from 16.3 points in period A to 22.4 and 20.4 in periods B and C, respectively (p = 0.007). Waitlist mortality decreased from 18.4% in period A to 10.4% and 9.4% in periods B and C, respectively (p = 0.015). Three-month mortality did not change significantly (10% each for periods A, B and C). One-year survival was 84% for the MELD 6-19 group compared with 81% in the MELD 20-29 group and 74% in the MELD ≥30 group (p = 0.823). Analyzing MELD score and previously described prognostic scores [i.e. survival after liver transplantation (SALT) score and donor-MELD (D-MELD) score] with regard to 1-year survival, only a high risk SALT score was predictive (p = 0.038). In our center, 2 years after implementation of the MELD system, waitlist mortality decreased, while 90-day mortality did not change significantly.
Up to now, only the SALT score proved to be of prognostic relevance post-transplant.
2006年12月16日，多数欧洲移植国家将基于等待时间的肝脏分配政策转变为基于紧急程度的终末期肝病模型（MELD）系统。关于这一政策变化在欧洲移植群体中的影响，相关数据有限。
回顾性分析了154例接受尸体供肝移植（LT）的患者，分为三个时间段：A期（MELD系统实施前1年，n = 42）、B期（MELD系统实施后1年，n = 52）和C期（MELD系统实施2年后，n = 60）。
LT时的MELD评分中位数从A期的16.3分分别增至B期的22.4分和C期的20.4分（p = 0.007）。等待名单上的死亡率从A期的18.4%分别降至B期的10.4%和C期的9.4%（p = 0.015）。三个月死亡率无显著变化（A、B、C期均为10%）。MELD 6 - 19组的1年生存率为84%，MELD 20 - 29组为81%，MELD≥30组为74%（p = 0.823）。分析MELD评分以及先前描述的预后评分[即肝移植后生存率（SALT）评分和供体MELD（D - MELD）评分]与1年生存率的关系，只有高风险SALT评分具有预测性（p = 0.038）。在我们中心，MELD系统实施2年后，等待名单上的死亡率降低，而90天死亡率无显著变化。
到目前为止，只有SALT评分在移植后具有预后相关性。
