Hajifathalian Kaveh, Humberson Annette, Hanouneh Mohamad A, Barnes David S, Arora Zubin, Zein Nizar N, Eghtesad Bijan, Kelly Dympna, Hanouneh Ibrahim A
Kaveh Hajifathalian, Mohamad A Hanouneh, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States.
World J Hepatol. 2016 Sep 28;8(27):1149-1154. doi: 10.4254/wjh.v8.i27.1149.
To evaluate risk of recidivism on a case-by-case basis.
From our center's liver transplant program, we selected patients with alcoholic liver disease who were listed for transplant based on Ohio Solid Organ Transplantation Consortium (OSOTC) exception criteria. They were considered to have either a low or medium risk of recidivism, and had at least one or three or more months of abstinence, respectively. They were matched based on gender, age, and Model for End-Stage Liver Disease (MELD) score to controls with alcohol-induced cirrhosis from Organ Procurement and Transplant Network data.
Thirty six patients with alcoholic liver disease were approved for listing based on OSOTC exception criteria and were matched to 72 controls. Nineteen patients (53%) with a median [Inter-quartile range (IQR)] MELD score of 24 (13) received transplant and were followed for a median of 3.4 years. They were matched to 38 controls with a median (IQR) MELD score of 25 (9). At one and five years, cumulative survival rates (± standard error) were 90% ± 7% and 92% ± 5% and 73% ± 12% and 77% ± 8% in patients and controls, respectively (Log-rank test, = 0.837). Four (21%) patients resumed drinking by last follow-up visit.
Compared to traditional criteria for assessment of risk of recidivism, a careful selection process with more flexibility to evaluate eligibility on a case-by-case basis can lead to similar survival rates after transplantation.
逐案评估再犯风险。
从我们中心的肝移植项目中，我们选择了根据俄亥俄州实体器官移植联盟（OSOTC）例外标准被列入移植名单的酒精性肝病患者。他们被认为再犯风险低或中等，分别有至少1个月或3个月或更长时间的戒酒期。根据性别、年龄和终末期肝病模型（MELD）评分，将他们与器官获取与移植网络数据中的酒精性肝硬化对照组进行匹配。
36例酒精性肝病患者根据OSOTC例外标准被批准列入名单，并与72例对照匹配。19例患者（53%），MELD评分中位数[四分位间距（IQR）]为24（13），接受了移植，中位随访3.4年。他们与38例对照匹配，MELD评分中位数（IQR）为25（9）。在1年和5年时，患者和对照组的累积生存率（±标准误）分别为90%±7%和92%±5%以及73%±12%和77%±8%（对数秩检验，P = 0.837）。4例（21%）患者在最后一次随访时恢复饮酒。
与传统的再犯风险评估标准相比，一个更具灵活性、能逐案评估 eligibility 的仔细筛选过程可导致移植后相似的生存率。 （注：原文中eligibility含义不太明确，可能存在翻译不准确情况）
