Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Am J Transplant. 2017 Jul;17(7):1833-1842. doi: 10.1111/ajt.14198. Epub 2017 Feb 24.
The large volume of adult living donor liver transplantations (ALDLTs) at our center affords a unique opportunity to examine the impact of acute-on-chronic liver failure (ACLF) among high-Model for End-Stage Liver Disease MELD score patients. From February 1998 to March 2010, 1958 cirrhotic recipients were analyzed to study the relationship between MELD scores and ALDLT outcomes. A total of 327 high-MELD score recipients were categorized into ACLF and non-ACLF groups, and their outcomes were compared. The 5-year graft and patient survival in the high-MELD group were 75.2% and 76.4%, respectively, which were significantly worse than the low and intermediate MELD groups. The presence of ACLF associated with higher MELD scores appeared to be the dominant factor responsible for the inferior results of patients with MELD score of 30-34 points. The 5-year graft survivals in the ACLF group was 70.5% and in the non-ACLF group it was 81.0% (p = 0.035). Therefore, ALDLT should be performed as soon as possible in high-MELD score patients prior to ACLF development. Moreover, ACLF patients should be separately categorized when analyzing the outcomes of ALDLT. ALDLT for ACLF patients should not be discouraged because favorable outcomes can be expected through timely ALDLT and comprehensive management.
在我们中心，大量的成人活体肝移植（ALDLT）为研究高终末期肝病模型（MELD）评分患者的慢加急性肝衰竭（ACLF）的影响提供了独特的机会。1998 年 2 月至 2010 年 3 月，我们分析了 1958 例肝硬化受者，以研究 MELD 评分与 ALDLT 结果的关系。将 327 例高 MELD 评分受者分为 ACLF 和非 ACLF 组，并比较其结果。高 MELD 组的 5 年移植物和患者存活率分别为 75.2%和 76.4%，明显低于低和中 MELD 组。具有较高 MELD 评分的 ACLF 的存在似乎是导致 MELD 评分 30-34 分患者结果较差的主要因素。ACLF 组的 5 年移植物存活率为 70.5%，非 ACLF 组为 81.0%（p = 0.035）。因此，在 ACLF 发生之前，应尽快对高 MELD 评分患者进行 ALDLT。此外，在分析 ALDLT 结果时，应单独对 ACLF 患者进行分类。不应因 ACLF 患者的 ALDLT 而气馁，因为通过及时的 ALDLT 和综合管理可以获得良好的结果。
