Lai J C, Roberts J P
Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA.
Division of Transplant Surgery, Department of Surgery, University of California-San Francisco, San Francisco, CA.
Am J Transplant. 2016 Aug;16(8):2430-6. doi: 10.1111/ajt.13763. Epub 2016 Apr 1.
Under the United Network for Organ Sharing (UNOS) policy, deceased donor livers may be offered to ABO-nonidentical candidates at each given Model for End-Stage Liver Disease (MELD) score and to blood type B candidates at MELD ≥30. To evaluate ABO-nonidentical liver transplantation (LT) in the United States, we examined all adult LT non-status 1 candidates, recipients and deceased liver donors from 2013 to 2015. There were 34 920 LT candidates (47% type O, 38% type A, 12% type B, 3% type AB) and 10 479 deceased liver donors (47% type O, 38% type A, 12% type B, 3% type AB). ABO-nonidentical LT occurred in 2%, 3%, 20% and 36% of types O, A, B and AB recipients, respectively, which led to a net liver loss of 6% for type O and 2% for type A recipients but a net liver gain of 14% for type B and 55% for type AB recipients. The LT MELD scores of ABO-identical versus -nonidentical recipients were 29 versus 34 for type O, 29 versus 19 for type A, 25 versus 38 for type B, and 22 versus 28 for type AB (p < 0.01). ABO-nonidentical LT increased liver supply for candidates with blood types B and AB but decreased supply for type O and A candidates. We urge refinement of UNOS policy surrounding ABO-nonidentical LT.
根据器官共享联合网络（UNOS）的政策，在每个给定的终末期肝病模型（MELD）评分下，已故捐赠者的肝脏可提供给ABO血型不匹配的候选人；对于MELD≥30的B型血候选人也可提供。为评估美国ABO血型不匹配的肝移植（LT）情况，我们研究了2013年至2015年所有成年LT非1类候选人、受者及已故肝脏捐赠者。有34920名LT候选人（47%为O型血，38%为A型血，12%为B型血，3%为AB型血）以及10479名已故肝脏捐赠者（47%为O型血，38%为A型血，12%为B型血，3%为AB型血）。ABO血型不匹配的LT分别发生在2%的O型血、3%的A型血、20%的B型血和36%的AB型血受者中，这导致O型血受者肝脏净损失6%，A型血受者肝脏净损失2%，而B型血受者肝脏净增加14%，AB型血受者肝脏净增加55%。ABO血型匹配与不匹配受者的LT MELD评分在O型血中分别为29和34，A型血中分别为29和19，B型血中分别为25和38，AB型血中分别为22和28（p<0.01）。ABO血型不匹配的LT增加了B型血和AB型血候选人的肝脏供应，但减少了O型血和A型血候选人的肝脏供应。我们敦促完善围绕ABO血型不匹配LT的UNOS政策。
