Yadav Sanjay K, Saraf Neeraj, Saigal Sanjiv, Choudhary Narendra S, Goja Sanjay, Rastogi Amit, Bhangui Prashant, Soin Arvinder S
Institute of Liver Transplant and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Delhi (NCR), India.
Clin Transplant. 2017 Aug;31(8). doi: 10.1111/ctr.13006.
In countries where deceased organ donation is scarce, there is a big gap between demand and supply of organs and living donor liver transplantation (LDLT) plays an important role in meeting this unmet need. This study was conducted to analyze the effect of pretransplant Model for End-stage Liver Disease (MELD) score on outcomes following LDLT. The outcome of 1000 patients who underwent LDLT from July 2010 to March 2015 was analyzed retrospectively. Patients were grouped into low MELD<25 and high MELD ≥25 score to compare short-term outcomes. Cumulative overall survival rates were calculated using Kaplan-Meier methods. A total of 849 recipients were in low MELD group (Mean MELD=16.90±9.2) and 151 were in high MELD group (Mean MELD=28.77±7.2). No significant difference in etiology of CLD was observed between groups except for a higher prevalence of hepatitis C virus (29.6% vs 19.9%, P=.01) in low MELD patients. No significant difference was observed in 1-year survival (88.5% vs 84.1%, P=.12) between the groups. The multivariate analysis showed that pretransplant MELD score does not predict survival of recipients. Pretransplant high MELD score does not adversely affect outcomes after LDLT. In view of shortage of deceased organs, LDLT can be a good option in high MELD recipients.
在尸体器官捐赠稀缺的国家，器官供需之间存在巨大差距，活体肝移植（LDLT）在满足这一未得到满足的需求方面发挥着重要作用。本研究旨在分析移植前终末期肝病模型（MELD）评分对活体肝移植术后结局的影响。回顾性分析了2010年7月至2015年3月期间接受活体肝移植的1000例患者的结局。将患者分为低MELD<25分和高MELD≥25分两组，比较短期结局。采用Kaplan-Meier方法计算累积总生存率。低MELD组共有849例受者（平均MELD=16.90±9.2），高MELD组有151例（平均MELD=28.77±7.2）。除低MELD患者丙型肝炎病毒患病率较高（29.6%对19.9%，P=0.01）外，两组间慢性肝病病因无显著差异。两组间1年生存率无显著差异（88.5%对84.1%，P=0.12）。多因素分析显示，移植前MELD评分不能预测受者的生存情况。移植前高MELD评分对活体肝移植术后结局无不利影响。鉴于尸体器官短缺，活体肝移植对于高MELD受者可能是一个不错的选择。
