终末期肝病模型（MELD）评分>40的终末期肝病患者与1A类患者相比，等待名单上的死亡率更高。
End-stage liver disease patients with MELD >40 have higher waitlist mortality compared to Status 1A patients.
作者信息
Ahn Joseph, Bhuket Taft, Mosadeghi Sasan, Frenette Catherine, Liu Benny, Wong Robert J
机构信息
School of Medicine, University of California, San Francisco, CA, USA.
Endoscopy Unit, Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, 1411 East 31st Street, Highland Hospital-Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA.
出版信息
Hepatol Int. 2016 Sep;10(5):838-46. doi: 10.1007/s12072-016-9735-4. Epub 2016 May 24.
BACKGROUND AND AIMS
Status 1A patients are prioritized over end-stage liver disease (ESLD) for liver transplantation (LT). ESLD patients with high MELD may have higher waitlist mortality than Status 1A patients, and may require LT more urgently.
METHODS
Using United Network for Organ Sharing registry data, we retrospectively evaluated LT waitlist mortality and probability of LT between adults in the United States with Status 1A or ESLD with MELD >30 listed for LT from 2003-2013. Overall waitlist mortality and probability of LT were evaluated with Kaplan-Meier and multivariate logistic regression models.
RESULTS
From 2003-2013, 15,049 ESLD patients with MELD >30 and 3049 Status 1A patients were listed for LT. While overall 14-day waitlist survival decreased with increasing MELD score among ESLD patients (54.0 % for MELD 31-35; 37.1 % for MELD 36-40; 27.5 % for MELD >40), overall survival at 14 days was significantly lower among Status 1A (14.4 %). Compared to Status 1A, ESLD patients with MELD >40 had significantly higher 14-day waitlist mortality (OR 1.92; 95 % CI 1.56-2.36; p < 0.001), whereas ESLD patients with MELD 36-40 had a non-significant trend towards higher waitlist mortality (OR 1.16; 95 % CI 0.93-1.45; p = 0.181). No difference in probability of LT within 14 days was observed between ESLD with MELD >40 and Status 1A (p = 0.89). ESLD patients with MELD >40 had higher post-LT survival compared to Status 1A on multivariate regression modeling (HR 0.80; 95 % CI 0.66-0.96; p < 0.02).
CONCLUSION
Among adults in the United States awaiting LT, ESLD patients with MELD >40 have significantly higher waitlist mortality, but similar probability of receiving LT compared to Status 1A patients.
背景与目的
在肝移植（LT）中，1A 级患者比终末期肝病（ESLD）患者具有更高的优先级。终末期肝病模型（MELD）评分高的 ESLD 患者可能比 1A 级患者有更高的等待名单死亡率，并且可能更迫切需要肝移植。
方法
利用器官共享联合网络登记数据，我们回顾性评估了 2003 年至 2013 年期间在美国等待肝移植、MELD 评分>30 的 1A 级或 ESLD 成年患者的肝移植等待名单死亡率和肝移植概率。采用 Kaplan-Meier 法和多因素逻辑回归模型评估总体等待名单死亡率和肝移植概率。
结果
2003 年至 2013 年期间，有 15049 例 MELD 评分>30 的 ESLD 患者和 3049 例 1A 级患者被列入肝移植等待名单。虽然 ESLD 患者中，随着 MELD 评分增加，总体 14 天等待名单生存率下降（MELD 31 - 35 为 54.0%；MELD 36 - 40 为 37.1%；MELD>40 为 27.5%），但 1A 级患者的 14 天总体生存率显著更低（14.4%）。与 1A 级相比，MELD>40 的 ESLD 患者 14 天等待名单死亡率显著更高（比值比 1.92；95%置信区间 1.56 - 2.36；p<0.001），而 MELD 36 - 40 的 ESLD 患者等待名单死亡率有升高趋势但无统计学意义（比值比 1.16；95%置信区间（0.93 - 1.45；p = 0.181）。MELD>40 的 ESLD 患者与 1A 级患者在 14 天内接受肝移植的概率无差异（p = 0.89）。多因素回归模型显示，MELD>40 的 ESLD 患者肝移植后生存率高于 1A 级患者（风险比 0.80；95%置信区间 0.66 - 0.96；p<0.02）。
结论
在美国等待肝移植的成年患者中，MELD>40 的 ESLD 患者等待名单死亡率显著更高，但与 1A 级患者相比，接受肝移植的概率相似。
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