Chinnaratha Mohamed A, Chelvaratnam Uthayanan, Stuart Katherine A, Strasser Simone I, McCaughan Geoffrey W, Gow Paul, Adams Leon A, Wigg Alan J
South Australian Liver Transplant Unit, Flinders Medical Centre, Bedford Park, Australia; Flinders University of South Australia, Adelaide, Australia.
Liver Transpl. 2014 Jul;20(7):798-806. doi: 10.1002/lt.23894.
An increased liver disease burden has been reported for Aboriginal and Torres Strait Islanders (ATSIs) in Australia; however, few proceed to liver transplantation (LT). We aimed to compare overall survival and graft survival after LT between ATSI and non-ATSI populations, assess the factors influencing survival within ATSIs, and finally examine the proportion of ATSIs undergoing LT. This study was a retrospective review of the Australia and New Zealand Liver Transplant Registry from 1985 to 2012 and examined consecutive primary LT performed in Australia. Overall and graft survival were compared between ATSI and non-ATSI groups. The Accessibility/Remoteness Index of Australia (ARIA) was used to calculate the remoteness of individuals. There were 3493 primary LT performed, and 45 patients (1.3%; 14 children and 31 adults) were ATSIs. The median (range) ages of the ATSI children and adults at the time of LT were 9.6 (0.2-15.3) years and 44.5 (19.5-65.5) years, respectively. There were 10 deaths in the ATSI cohort. The median (range) overall survival was similar for ATSI and non-ATSI children [6.5 (0.1-23.5) years versus 9.0 (0-28.2) years, P = 0.9] and adults [7.1 (0.1-15.7) years versus 6.3 0-26.7) years, P = 0.8]. The cumulative graft survival was similar for ATSI and non-ATSI children (P = 0.8) and adults (P = 0.8). High ARIA scores [hazard ratio (HR) = 1.2, 95% confidence interval (CI) = 1.01-1.53, P = 0.03] in children and blood group O (HR = 3.8, 95% CI = 1.1-12.7, P = 0.03) in adults predicted worse outcomes for ATSIs. Although ATSIs accounted for 4.7% and 1.8% of the Australian pediatric and adult populations, respectively, they represented only 2.2% of pediatric LT recipients (χ(2) = 8.2, P = 0.004) and 1.1% of adult LT recipients (χ(2) = 7.9, P = 0.005). In conclusion, overall survival and graft survival after LT are comparable in ATSIs and non-ATSIs. There is a trend toward increased death/retransplantation in ATSIs from remote areas. ATSI children and adults appear to be underrepresented in the Australian LT population.
据报道，澳大利亚原住民和托雷斯海峡岛民（ATSI）的肝脏疾病负担有所增加；然而，很少有人会接受肝移植（LT）。我们旨在比较ATSI人群和非ATSI人群肝移植后的总生存率和移植物生存率，评估影响ATSI人群生存的因素，最后研究接受肝移植的ATSI人群的比例。本研究是对1985年至2012年澳大利亚和新西兰肝移植登记处的回顾性分析，研究对象为在澳大利亚连续进行的首次肝移植。比较了ATSI组和非ATSI组的总生存率和移植物生存率。使用澳大利亚可及性/偏远指数（ARIA）来计算个体的偏远程度。共进行了3493例首次肝移植，其中45例患者（1.3%；14名儿童和31名成人）为ATSI人群。ATSI儿童和成人肝移植时的中位（范围）年龄分别为9.6（0.2 - 15.3）岁和44.5（19.5 - 65.5）岁。ATSI队列中有10例死亡。ATSI儿童和非ATSI儿童的中位（范围）总生存率相似[6.5（0.1 - 23.5）年对9.0（0 - 28.2）年，P = 0.9]，成人也相似[7.1（0.1 - 15.7）年对6.3（0 - 26.7）年，P = 0.8]。ATSI儿童和非ATSI儿童的累积移植物生存率相似（P = 0.8），成人也相似（P = 0.8）。儿童高ARIA评分[风险比（HR）= 1.2，95%置信区间（CI）= 1.01 - 1.53，P = 0.03]和成人血型O（HR = 3.8，95% CI = 1.1 - 12.7，P = 0.03）预示着ATSI人群的预后较差。尽管ATSI人群分别占澳大利亚儿童和成人人口的4.7%和1.8%，但他们仅占儿童肝移植受者的2.2%（χ(2) = 8.2，P = 0.004）和成人肝移植受者的1.1%（χ(2) = 7.9，P = 0.005）。总之，ATSI人群和非ATSI人群肝移植后的总生存率和移植物生存率相当。偏远地区的ATSI人群有死亡/再次移植增加的趋势。ATSI儿童和成人在澳大利亚肝移植人群中的占比似乎较低。
