Leibovici-Weissman Yaara, Mor Eytan, Leshno Moshe, Shlomai Amir
Department of Internal Medicine D, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Street, Petah-Tikva, 49100, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Dig Dis Sci. 2017 Mar;62(3):801-807. doi: 10.1007/s10620-016-4423-8. Epub 2017 Jan 4.
The model of end-stage liver disease (MELD) score is the standard tool for prioritizing patients awaiting liver transplantation. There is currently no definite high cutoff score reflecting disease severity that might exclude patients from transplantation. Furthermore, the age limit that used to disqualify patients from eligibility to transplantation was recently withdrawn in several countries.
The aims of this study were to assess the effects of MELD score and age at time of transplantation on patients' short- and long-term survival.
We conducted a retrospective single-center study on a cohort of patients transplanted for the first time due to non-fulminant liver failure.
Four hundred and seventeen patients (mean age 50.2 years, 63% males) who underwent liver transplantation for the first time were included. Both higher patients' and donors' age were significantly associated with increased long-term mortality (p = 0.007, 95% CI 1.006-1.038 for patient age, p = 0.02, 95% CI 1.002-1.023 for donor age). Patients' age remained significantly associated with survival at 1 year post-transplantation, as well. We found no association between higher MELD score at transplantation and long-term mortality (p = 0.189, 95% CI 0.99-1.051) irrespective of patients' age. Specifically, when patients were divided according to their MELD score at transplantation (MELD < 15, MELD 15-25 and MELD > 25), no significant differences in long-term survival were detected between these three subgroups. Results did not differ significantly in a subgroup analysis of patients without hepatocellular carcinoma at the time of transplantation.
Patients' and donors' age rather than patients' MELD score at transplantation determine survival following liver transplantation.
终末期肝病模型（MELD）评分是对等待肝移植患者进行优先排序的标准工具。目前尚无明确的高截断评分来反映疾病严重程度，从而可能将患者排除在移植之外。此外，过去曾使患者失去移植资格的年龄限制最近在一些国家已被取消。
本研究的目的是评估MELD评分和移植时年龄对患者短期和长期生存的影响。
我们对一组因非暴发性肝衰竭首次接受移植的患者进行了回顾性单中心研究。
纳入了417例首次接受肝移植的患者（平均年龄50.2岁，63%为男性）。患者和供体年龄越大，长期死亡率越高（患者年龄p = 0.007，95%可信区间1.006 - 1.038；供体年龄p = 0.02，95%可信区间1.002 - 1.023）。患者年龄在移植后1年时也与生存率显著相关。无论患者年龄如何，我们发现移植时较高的MELD评分与长期死亡率之间无关联（p = 0.189，95%可信区间0.99 - 1.051）。具体而言，当根据移植时的MELD评分将患者分为三组（MELD < 15、MELD 15 - 25和MELD > 25）时，这三个亚组之间未检测到长期生存的显著差异。在移植时无肝细胞癌患者的亚组分析中，结果无显著差异。
肝移植后的生存取决于患者和供体的年龄，而非患者移植时的MELD评分。
