Cholongitas Evangelos, Burroughs Andrew K
4th Department of Internal Medicine, Medical School of Aristotle University, Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece (Evangelos Cholongitas) ; The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery, Royal Free Hospital and UCL, London, UK (Evangelos Cholongitas, Andrew K. Burroughs).
The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery, Royal Free Hospital and UCL, London, UK (Evangelos Cholongitas, Andrew K. Burroughs).
Ann Gastroenterol. 2012;25(1):6-13.
Policies for organ allocation can be based on medical urgency, utility or transplant benefit. With an urgency policy, patients with worse outcomes on the waiting list are given higher priority for transplantation [based on the Child-Turcotte-Pugh score or the Model for End-stage Liver Disease (MELD) score, or United Kingdom model for End-stage Liver Disease (UKELD) score]. The MELD and UKELD scores have statistical validation and use objective and widely available laboratory tests. However, both scores have important limitations. Adjustments to the original MELD equation and new scoring systems have been proposed to overcome these limitations; incorporation of serum sodium improves its predictive accuracy and is part of the UKELD score. The utility-based systems are based on post-transplant outcome taking into account donor and recipient characteristics. MELD and UKELD scores poorly predict outcomes after liver transplantation due to the absence of donor factors. The transplant benefit models rank patients according to the net survival benefit that they would derive from transplantation. These models would be based on the maximization of the lifetime gained through liver transplantation. Well-designed prospective studies and simulation models are necessary to establish the optimal allocation system in liver transplantation, as no current model has all the best characteristics.
器官分配政策可以基于医疗紧迫性、效用或移植获益。采用紧迫性政策时，等待名单上预后较差的患者在移植时会被给予更高优先级（基于Child-Turcotte-Pugh评分或终末期肝病模型（MELD）评分，或英国终末期肝病模型（UKELD）评分）。MELD和UKELD评分经过统计学验证，且使用客观且广泛可得的实验室检查。然而，这两种评分都有重要局限性。已有人提出对原始MELD方程进行调整以及采用新的评分系统来克服这些局限性；纳入血清钠可提高其预测准确性，并且血清钠是UKELD评分的一部分。基于效用的系统是根据移植后的结果并考虑供体和受体特征。由于缺乏供体因素，MELD和UKELD评分对肝移植后的结果预测不佳。移植获益模型根据患者从移植中获得的净生存获益对患者进行排名。这些模型将基于通过肝移植获得的寿命最大化。由于目前没有一个模型具备所有最佳特征，因此需要精心设计的前瞻性研究和模拟模型来建立肝移植的最佳分配系统。
