Transplant Center, University of Kentucky College of Medicine, Lexington, KY 40536-0293, USA.
HPB (Oxford). 2013 Apr;15(4):302-6. doi: 10.1111/j.1477-2574.2012.00579.x. Epub 2012 Sep 21.
The purpose of this study was to determine peri-operative mortality and long-term outcomes in patients undergoing liver transplantation in the US using the United Network for Organ Sharing (UNOS) database.
This study is a retrospective review of liver transplantations (LT) recorded in the UNOS database performed between 1988 and 2010. In total, 107 411 LT were performed in the US, 357 (0.3%) were for adult polycystic liver disease (PLD). A random group of 9416 adult patients transplanted for other diagnoses was created for comparison (10% of the adult non-PLD database).
Two hundred and seventy-one patients in the adult PLD group were females (75.9%), the mean age was 52.3 ± 8.2 [standard deviation (SD)] years. The median length of transplantation hospital stay was 11 days (interquartile range 8-21). Patients from the PLD group versus the comparison group (9416 patients) consisted of more females, lower Model for End-Stage Liver Disease (MELD) scores (17 versus 21 points), more multi-organ transplants (41% versus 4 %), chronic renal failure (creatinine 2.7 versus 1.5) and fewer patients with chronic hepatitis C (1.4% versus 32%). Peri-operative mortality (≤30 days) was 9% in the PLD versus 6% in the comparison group; however, at 1 year PLD survival was similar (85% versus 85%) to other diagnoses and better at 3 (81% versus 77%) and 5 years (77% versus 71%, overall Log Rank P = 0.006). A similar PLD survival advantage was observed in isolated initial transplants (P = 0.019).
In spite of early technical challenges and mortality, transplantation should be considered an option for selected patients with PLD as excellent long-term outcomes can be achieved.
本研究旨在使用美国器官共享联合网络（UNOS）数据库确定接受肝移植患者的围手术期死亡率和长期结果。
本研究是对 1988 年至 2010 年期间 UNOS 数据库中记录的肝移植（LT）进行的回顾性研究。美国共进行了 107411 例 LT，其中 357 例（0.3%）为成人多囊肝病（PLD）。为了进行比较，创建了一个随机的 9416 名接受其他诊断的成人患者组（成人非 PLD 数据库的 10%）。
成人 PLD 组中有 271 名女性（75.9%），平均年龄为 52.3±8.2[标准差（SD）]岁。移植住院时间中位数为 11 天（四分位间距 8-21）。PLD 组与对照组（9416 名患者）相比，女性更多，终末期肝病模型（MELD）评分较低（17 分比 21 分），多器官移植更多（41%比 4%），慢性肾衰竭（肌酐 2.7 比 1.5），慢性丙型肝炎患者更少（1.4%比 32%）。PLD 组的围手术期死亡率（≤30 天）为 9%，对照组为 6%；然而，1 年时 PLD 生存率与其他诊断相似（85%比 85%），3 年（81%比 77%）和 5 年（77%比 71%）时更好（总体对数秩 P=0.006）。孤立性初始移植中也观察到 PLD 生存优势（P=0.019）。
尽管存在早期技术挑战和死亡率，但对于选定的 PLD 患者，肝移植应被视为一种选择，因为可以获得极好的长期结果。
