不同年龄组丙型肝炎病毒患者肝移植的不同结局：终末期肝病评分模型的影响

Variant outcomes of liver transplantation for hepatitis C virus patients in different age categories: impact of the model for end-stage liver disease score.

作者信息

Hu Zhenhua, Zhou Jie, Li Zhiwei, Xiang Jie, Zhang Qijun, Yan Sheng, Wu Jian, Zhang Min, Wang Weilin, Zheng Shusen

机构信息

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.

Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.

出版信息

J Hepatobiliary Pancreat Sci. 2017 Apr;24(4):206-216. doi: 10.1002/jhbp.435. Epub 2017 Mar 19.

DOI:10.1002/jhbp.435

PMID:28107613

Abstract

BACKGROUND

Whether the introduction of model for end-stage liver disease (MELD) has an effect on transplant outcome for different age categories remain unclear.

METHODS

We analyzed 49,762 adult hepatitis C virus (HCV) candidates through 1 January 1995 to 31 December 2012 from the Scientific Registry of Transplant Recipients. Patients were divided into four age categories (18-34, 35-49, 60-64, ≥65 years) in the pre-MELD era and MELD era, respectively.

RESULTS

Waiting list dropouts have decreased in the MELD era for all categories. A reduced trend in survival was observed for 18-34 years patients in the MELD era compared with the pre-MELD era, with 5-year intention-to-treat, overall and graft survival of 56.5%, 57.9%, 56.3% vs. 56.4%, 69.7%, 64.4% (P = 0.604, 0.034, and 0.071, respectively). For other age categories, survival rates were all superior in the MELD era. Cox-regression analysis showed values of hazard ratio for age increased with advanced age (all >1) in the pre-MELD era compared with the reference group (18-34 years), while these hazard ratios were <1 for overall and graft survival in MELD era.

CONCLUSIONS

Our study provides useful evidence that the introduction of MELD for liver allocation may adversely affect survival of specific HCV patients.

摘要

背景

终末期肝病模型（MELD）的引入对不同年龄组的移植结局是否有影响尚不清楚。

方法

我们分析了来自移植受者科学登记处的49762例成年丙型肝炎病毒（HCV）候选者，时间跨度从1995年1月1日至2012年12月31日。在MELD时代之前和MELD时代，患者分别被分为四个年龄组（18 - 34岁、35 - 49岁、60 - 64岁、≥65岁）。

结果

在MELD时代，所有年龄组的等待名单退出率均有所下降。与MELD时代之前相比，MELD时代18 - 34岁患者的生存呈下降趋势，其5年意向性治疗、总体和移植物生存率分别为56.5%、57.9%、56.3%，而之前分别为56.4%、69.7%、64.4%（P分别为0.604、0.034和0.071）。对于其他年龄组，MELD时代的生存率均更高。Cox回归分析显示，与参照组（18 - 34岁）相比，MELD时代之前年龄的风险比随着年龄增长而升高（均>1），而在MELD时代，总体和移植物生存的这些风险比<1。