2007年至2012年全国共享肝脏移植供体的医院利用情况

Hospital Utilization of Nationally Shared Liver Allografts from 2007 to 2012.

作者信息

Ertel Audrey E, Wima Koffi, Hoehn Richard S, Abbott Daniel E, Shah Shimul A

机构信息

Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA.

Division of Transplant Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0558, MSB 2006C, Cincinnati, OH, 45267-0558, USA.

出版信息

World J Surg. 2016 Apr;40(4):958-66. doi: 10.1007/s00268-015-3357-1.

DOI:10.1007/s00268-015-3357-1

PMID:26643514

Abstract

BACKGROUND

Due to the current geographic disparities in liver allocation a policy, which endorses broader sharing of allografts, has been proposed. We performed a retrospective cohort study to identify how nationally shared allografts, under the current policy, affect perioperative outcomes and resource utilization following liver transplantation (LT).

METHODS

Univariate and multivariate analysis identified how patient characteristics and hospital outcomes were associated with national sharing. This analysis was based on 12,282 deceased donor liver transplants performed between 2007 and 2012 using the scientific registry of transplant recipients linked to the University HealthSystem Consortium database.

RESULTS

Compared to locally distributed livers, nationally shared livers are more likely to have a donor risk index >1.8 (64.3 vs. 11.6 %), to be classified as expanded criteria donors (44.6 vs. 24.8 %), and transplanted into healthier recipients. Nationally shared LTs were more likely to be performed at high-volume centers (49.1 vs. 30.6 %), resulted in longer length of stay (11 vs. 9 days), and had higher in-hospital mortality (6.6 vs. 3.3 %). Additionally, nationally shared allografts were independent predictors of in-hospital mortality (OR 1.64, 95 % CI 1.13-2.39) and length of stay (OR 1.12, 95 % CI 1.02-1.21).

CONCLUSION

These data suggest that increased national sharing of livers may result in inferior patient outcomes and increased resource utilization.

摘要

背景

由于目前肝脏分配政策存在地域差异，有人提出了一项支持扩大同种异体移植物共享范围的政策。我们进行了一项回顾性队列研究，以确定在当前政策下全国共享的同种异体移植物如何影响肝移植（LT）后的围手术期结局和资源利用情况。

方法

单因素和多因素分析确定了患者特征和医院结局与全国共享之间的关联。该分析基于2007年至2012年期间使用与大学卫生系统联盟数据库相关联的移植受者科学登记处进行的12282例尸体供肝肝移植。

结果

与本地分配的肝脏相比，全国共享的肝脏更有可能供体风险指数>1.8（64.3%对11.6%），被归类为扩大标准供体（44.6%对24.8%），并移植给更健康的受者。全国共享的肝移植更有可能在高容量中心进行（49.1%对30.6%），住院时间更长（11天对9天），院内死亡率更高（6.6%对3.3%）。此外，全国共享的同种异体移植物是院内死亡率（OR 1.64，95%CI 1.13 - 2.39）和住院时间（OR 1.12，95%CI 1.02 - 1.21）的独立预测因素。