供体年龄与术前终末期肝病模型（MELD）评分的乘积——D-MELD，可预测活体肝移植后的手术结局，尤其是在丙型肝炎病毒（HCV）阳性及接受较小移植物的受者中。

D-MELD, the Product of Donor Age and Preoperative MELD, Predicts Surgical Outcomes After Living Donor Liver Transplantation, Especially in the Recipients With HCV-positive and Smaller Grafts.

作者信息

Tanemura A, Mizuno S, Kato H, Murata Y, Kuriyama N, Azumi Y, Kishiwada M, Usui M, Sakurai H, Isaji S

机构信息

Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, Japan.

出版信息

Transplant Proc. 2016 May;48(4):1025-31. doi: 10.1016/j.transproceed.2015.12.090.

DOI:10.1016/j.transproceed.2015.12.090

PMID:27320548

Abstract

BACKGROUND

Appropriate donor-recipient match has not been explored well in living-donor liver transplantation (LDLT) unlike deceased-donor liver transplantation. In this study, we evaluate the donor-recipient match using D-MELD (donor age × recipient Modified for End-stage Liver Disease [MELD] score) as a predictor of surgical outcomes in LDLT, paying attention to graft size and hepatitis C virus (HCV) status.

PATIENT AND METHODS

The 120 consecutive recipients who received adult-to-adult LDLT from March 2002 to December 2014 were divided into the two groups according to D-MELD score: D-MELD <1000 (low-D-MELD: n = 101) and D-MELD ≥1000 (high-D-MELD: n = 19).

RESULTS

The 90-day mortality rate was significantly higher in the high-DM group than in low-DM group: 36.8% versus 14.9% (P = .046). In the HCV-positive recipients, the 90-day mortality rate was significantly higher in high-DM group (n = 6) than in low-DM group (n = 37): 66.7% versus 13.5% (P = .012), and the 3-year survival rate was significantly lower in high-DM group than in the low-DM group: 33.3% versus 56.8% (P = .01). In the recipients with left graft, the 90-day mortality rate was significantly higher in the high-DM group (n = 8) than in the low-DM group (n = 41): 50% versus 14.6% (P = .044), and total bilirubin level on postoperative day 14 was significantly higher in the high-DM group than in the low-DM group: 17.4 mg/dL versus 9.2 mg/dL (P = .018).

CONCLUSIONS

It was clarified that D-MELD could predict early and long-term surgical outcomes in the recipients who were HCV-positive and who had smaller grafts.

摘要

背景

与尸体供肝肝移植不同，活体供肝肝移植（LDLT）中合适的供受体匹配情况尚未得到充分研究。在本研究中，我们使用供体年龄×受体终末期肝病模型（MELD）改良评分（D-MELD）评估供受体匹配情况，将其作为LDLT手术预后的预测指标，并关注移植物大小和丙型肝炎病毒（HCV）状态。

患者与方法

2002年3月至2014年12月期间连续接受成人对成人LDLT的120例受者，根据D-MELD评分分为两组：D-MELD＜1000（低D-MELD组：n = 101）和D-MELD≥1000（高D-MELD组：n = 19）。

结果

高D-MELD组90天死亡率显著高于低D-MELD组：36.8%对14.9%（P = 0.046）。在HCV阳性受者中，高D-MELD组（n = 6）的90天死亡率显著高于低D-MELD组（n = 37）：66.7%对13.5%（P = 0.012），高D-MELD组的3年生存率显著低于低D-MELD组：33.3%对56.8%（P = 0.01）。在接受左叶移植物的受者中，高D-MELD组（n = 8）的90天死亡率显著高于低D-MELD组（n = 41）：50%对14.6%（P = 0.044），高D-MELD组术后第14天总胆红素水平显著高于低D-MELD组：17.4mg/dL对9.2mg/dL（P = 0.018）。