Sivaprakasam Rajesh, Hidenori Takahashi, Pither Charlotte, Nishida Seigo, Butler Andrew J, Island Eddie R, Moon Jung, Dawwas Muhammad, Gabe Simon M, Jamieson Neville V, Tzakis Andreas G, Middleton Stephen J
Department of Gastroenterology and Transplantation, Addenbrooke's, Cambridge University Teaching Hospital, Cambridge CB2 0QQ, UK ; Transplantation Surgery, Addenbrooke's, Cambridge University Teaching Hospital, Cambridge CB2 0QQ, UK.
J Transplant. 2013;2013:202410. doi: 10.1155/2013/202410. Epub 2013 Apr 15.
We investigated the relationship between preoperative comorbidity and postoperative survival after intestinal transplantation. Each patient received a score for preoperative comorbidity. Each comorbidity was given a score based on the degree it impaired function (score range 0-3). A total score was derived from the summation of individual comorbidity scores. Patients (72 adults (M : F, 33 : 39)) received an isolated intestinal graft (27) or a cluster graft (45). Mean (standard deviation) survival was 1501 (1444) days. The Kaplan-Meier analysis revealed a significant inverse association between survival and comorbidity score (logrank test for trend, P < 0.0001). Patients grouped into comorbidity scores of 0 and 1, 2 and 3, 4 and 5, 6, and above had hazard ratios (95% confidence intervals) for death (compared to group 0 + 1), which increased with comorbidity scores: 1.945 (0.7622-5.816), 5.075 (3.314-36.17), and 13.77 (463.3-120100), respectively, (P < 0.0001). Receiver-operator curves at 1, 3, 5, and 10 years postoperative had "C" statistics of 0.88, 0.85, 0.88, and 0.92, respectively. When evaluating patients for transplantation, the degree of comorbidity should be considered as a major factor influencing postoperative survival.
我们研究了肠道移植术前合并症与术后生存率之间的关系。每位患者都获得了术前合并症评分。每种合并症根据其功能受损程度给予评分（评分范围为0 - 3分）。总分是由各个合并症评分相加得出的。患者（72名成年人（男∶女，33∶39））接受了孤立肠道移植（27例）或簇状移植（45例）。平均（标准差）生存期为1501（1444）天。Kaplan - Meier分析显示生存率与合并症评分之间存在显著的负相关（趋势对数秩检验，P < 0.0001）。合并症评分为0和1、2和3、4和5、6及以上的患者组（与0 + 1组相比）的死亡风险比（95%置信区间）随合并症评分增加：分别为1.945（0.7622 - 5.816）、5.075（3.314 - 36.17）和13.77（4.633 - 1201.00），（P < 0.0001）。术后1年、3年、5年和10年的受试者工作特征曲线的“C”统计量分别为0.88、0.85、0.88和0.92。在评估患者是否适合移植时，合并症程度应被视为影响术后生存的主要因素。
