Singal Ashwani K, Hasanin Mohsen, Kaif Mohamed, Wiesner Russell W, Kuo Yong-Fang
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham AL.
Division of Internal Medicine.
J Clin Gastroenterol. 2018 Jan;52(1):67-72. doi: 10.1097/MCG.0000000000000818.
Data are scanty on allocating simultaneous liver kidney (SLK) based on model for end-stage disease (MELD) score. Diabetes mellitus (DM) and hypertension (HTN) are frequent in cirrhosis patients. We analyzed transplant recipients with DM and/or HTN to compare MELD-based outcomes of SLK to liver transplantation alone (LTA).
Of 13,584 first deceased donor liver transplantation among patients with DM and/or HTN (1530 or 11.2% SLK), MELD score predicted SLK [1.02 (1.01-1.03)]. SLK was beneficial for 5-year patient survival at MELD score ≥43 (78.6% vs. 62.6%, P=0.017), but not at MELD score <29 (74.8% vs. 76.2%, P=0.63). Among 11,405 recipients (976 SLK) at MELD score <29, SLK (n=816) was beneficial compared with 706 LTA [75% vs. 64%, P<0.001; 0.71 (0.55-0.91)] at serum creatinine (SC) ≥2 but not at SC<2 [73% vs. 76%, P=0.32; 0.85 (0.60-1.2)]. Among patients with MELD score 29 to 42, SLK (n=484) and LTA (n=1403) had similar survival [69% vs. 69%, P=0.58; 0.9 (0.7-1.5)]. Among patients with MELD score ≥43, SLK (n=70) was associated with 35% improved patient survival at 5 years compared with 222 LTA [0.65 (0.46-0.93)].
Among patients with DM and/or HTN, SLK is useful at: (a) MELD score <29 and SC≥2 and (b) MELD score ≥43. Prospective studies are needed to confirm these findings as basis to optimize use of SLK.
关于基于终末期肝病模型（MELD）评分分配肝肾联合移植（SLK）的数据较少。糖尿病（DM）和高血压（HTN）在肝硬化患者中很常见。我们分析了患有DM和/或HTN的移植受者，以比较基于MELD评分的SLK与单纯肝移植（LTA）的结果。
在13584例患有DM和/或HTN的首次脑死亡供体肝移植患者中（1530例或11.2%为SLK），MELD评分预测SLK为[1.02（1.01 - 1.03）]。在MELD评分≥43时，SLK对患者5年生存率有益（78.6%对62.6%，P = 0.017），但在MELD评分<29时并非如此（74.8%对76.2%，P = 0.63）。在MELD评分<29的11405例受者（976例SLK）中，当血清肌酐（SC）≥2时，SLK（n = 816）与706例LTA相比有益[75%对64%，P<0.001；0.71（0.55 - 0.91）]，但在SC<2时并非如此[73%对76%，P = 0.32；0.85（0.60 - 1.2）]。在MELD评分为29至42的患者中，SLK（n = 484）和LTA（n = 1403）的生存率相似[69%对69%，P = 0.58；0.9（0.7 - 1.5）]。在MELD评分≥43的患者中，与222例LTA相比，SLK（n = 70）在5年时患者生存率提高了35%[0.65（0.46 - 0.93）]。
在患有DM和/或HTN的患者中，SLK在以下情况有用：（a）MELD评分<29且SC≥2，以及（b）MELD评分≥43。需要进行前瞻性研究以证实这些发现，作为优化SLK使用的依据。
