Nekrasov Victor, Matsuoka Lea, Kaur Navpreet, Pita Alejandro, Whang Gilbert, Cao Shu, Groshen Susan, Alexopoulos Sophoclis
1 Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA. 2 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA. 3 Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Transplantation. 2017 Oct;101(10):2360-2367. doi: 10.1097/TP.0000000000001738.
Organ donor shortages continue to persist, especially in regions of the United States where competition is highest and recipients frequently attain a Model for End-Stage Liver Disease (MELD) score of 40 or higher before transplantation. The benefits of Share 35 in highly competitive regions may be underestimated when examining the collective national experience. The purpose of this study was to examine the outcomes of liver transplantation in recipients with a MELD of 40 or higher after implementation of Share 35 in a single center located in region 5.
The method used in this study was single-center retrospective analysis of 207 liver transplant recipients who achieved MELD score of 40 or higher from April 21, 2002, to May 15, 2015.
Multivariable analysis identified implementation of Share 35 as the strongest predictor of graft survival in MELD of 40 or higher liver transplantation. The post-Share 35, 1-year graft survival was 94% compared with 75% pre-Share 35 (P = 0.002). Post-Share 35 recipients waited significantly less time until transplantation (10 vs 16 days, P = 0.015), and fewer were hospitalized for more than 28 days before their transplant (6% vs 18%, P = 0.05). Multivariable analysis identified recipients with diabetes at the time of listing as the strongest predictor of posttransplant patient mortality.
Implementation of the Share 35 allocation policy has a significant effect on outcomes by improving organ access and minimizing candidate waiting times. Recipients achieving a MELD of 40 or higher at our center post-Share 35 had an improved 1-year graft survival. However, nearly 40% remained hospitalized for more than 4 weeks posttransplant, and 20% were discharged to an acute care facility.
器官供体短缺问题依然存在，在美国竞争最为激烈的地区尤其如此，这些地区的受者在移植前经常达到终末期肝病模型（MELD）评分40或更高。在审视全国总体经验时，“共享35”政策在竞争激烈地区的益处可能被低估。本研究的目的是在位于第5区的一个单中心，探讨实施“共享35”政策后MELD评分40或更高的肝移植受者的移植结局。
本研究采用单中心回顾性分析方法，纳入2002年4月21日至2015年5月15日期间MELD评分达到40或更高的207例肝移植受者。
多变量分析确定，实施“共享35”政策是MELD评分40或更高的肝移植中移植物存活的最强预测因素。“共享35”政策实施后，1年移植物存活率为94%，而“共享35”政策实施前为75%（P = 0.002）。“共享35”政策实施后的受者等待移植的时间明显缩短（10天对16天，P = 0.015），移植前住院超过28天的人数也较少（6%对18%，P = 0.05）。多变量分析确定，登记时患有糖尿病的受者是移植后患者死亡的最强预测因素。
实施“共享35”分配政策通过改善器官获取和缩短候选者等待时间，对结局有显著影响。在我们中心，“共享35”政策实施后MELD评分达到40或更高的受者1年移植物存活率有所提高。然而，近40%的受者移植后仍住院超过4周，20%的受者出院后前往急性护理机构。
