Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA, USA.
Am J Transplant. 2012 Apr;12(4):947-53. doi: 10.1111/j.1600-6143.2011.03962.x. Epub 2012 Feb 2.
Once a liver offer has been refused locally and regionally, it is offered nationally. We characterized nationally (n = 1567) versus locally (n = 19 893) placed grafts from adult, nonfulminant, deceased donor liver transplants (LT) from 2/1/05 to 1/31/10. Donors of nationally versus locally placed livers differed by age (50 vs. 42 years), positive HCV antibody (11 vs. 2%) and death from stroke (51 vs. 42%) (p < 0.001 for all). Recipients of nationally versus locally placed livers differed by LT-MELD (20 vs. 24), rates of ascites (35 vs. 37%), encephalopathy (12 vs. 15%), hepatocellular (17 vs. 24%) and nonhepatocellular exceptions (6 vs. 11%) (p ≤ 0.03 for all). Six (5%) centers utilized 64% of the nationally placed grafts while 43 (38%) centers accepted zero during the 5-year period; all high volume centers used ≥1. Compared to local distribution, transplantation with a nationally placed liver was associated with a similar adjusted risk of graft (HR, 0.99; 95% CI, 0.86-1.14) and patient (HR, 0.98; 95% CI, 0.84-1.14; p = 0.77) survival. In conclusion, utilization of nationally placed livers is highly concentrated in very few centers, with no increased adjusted risk of graft loss. These findings provide the foundation for a more informed discussion about changing our current liver allocation and distribution policies.
一旦在本地和地区范围内拒绝了肝脏供体，就会在全国范围内提供。我们对 2005 年 2 月 1 日至 2010 年 1 月 31 日期间成人、非暴发性、已故供体肝移植（LT）中本地（n = 19893）和全国性（n = 1567）移植的供体进行了特征描述。与本地放置的肝脏相比，全国性放置的肝脏的供体在年龄（50 岁与 42 岁）、HCV 抗体阳性（11%与 2%）和因中风死亡（51%与 42%）方面存在差异（所有差异均<0.001）。与本地放置的肝脏相比，全国性放置的肝脏的受体在 LT-MELD（20 与 24）、腹水发生率（35%与 37%）、肝性脑病（12%与 15%）、肝细胞（17%与 24%）和非肝细胞（6%与 11%）方面存在差异（所有差异均≤0.03）。6（5%）个中心利用了 64%的全国性放置供体，而在 5 年期间，43（38%）个中心没有接受任何供体；所有高容量中心都使用了≥1 个。与本地分配相比，使用全国性放置的肝脏与移植后类似的调整后移植物（HR，0.99；95%CI，0.86-1.14）和患者（HR，0.98；95%CI，0.84-1.14；p = 0.77）生存率相关。总之，全国性放置的肝脏的利用率高度集中在极少数中心，调整后的移植物丢失风险没有增加。这些发现为更深入地讨论改变我们当前的肝脏分配和分配政策提供了基础。
