Lauferman Leandro, Dip Marcelo, Halac Esteban, Cervio Guillermo, Aredes Diego, Capparelli Mauro, Reijenstein Hayellen, Minetto Julia, Rojas Luis, Goñi Javier, Jacobo Dillon Agustina, Martinitto Roxana, Imventarza Oscar
Pediatric Liver Transplant, Hospital de Pediatria Prof Dr Juan P Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
Presidencia, Ente Autárquico Instituto de Trasplante, Ciudad Autónoma de Buenos Aires, Argentina.
Pediatr Transplant. 2018 Mar;22(2). doi: 10.1111/petr.13107. Epub 2018 Jan 3.
As PELD/MELD-based allocation policy was adopted in Argentina in 2005, a system of exception points has been in place in order to award increased waitlist priority to those patients whose severity of illness is not captured by the PELD/MELD score. We aimed to investigate the WL outcome of patients with granted PELD/MELD exceptions. A retrospective cohort study was conducted in children under 18 years old. WL outcomes were evaluated using univariable analysis. From 07/2005 to 01/2014, 408 children were listed for LT. There were 304 classified by calculated PELD/MELD. During this time, 85 (30%) PELD/MELD exceptions were granted. In this cohort, 89.4% (76 of 85) were transplanted and 7.1% (6 of 85) died while on the WL. The remaining 3 pts (3.5%) were removed from the WL due to other causes. We compared the impact of PELD/MELD exceptions in those 85 patients to outcomes in 87 non-exception patients with PELD/MELD ≥19 points. Patients with the exception had significantly better access to WL and lower WL mortality. Our data suggest that children listed by PELD/MELD exceptions had an advantage compared to children with CLD with equivalent PELD/MELD listing priorities.
由于阿根廷于2005年采用了基于PELD/MELD的分配政策，因此设立了一个例外积分系统，以便给予那些疾病严重程度未被PELD/MELD评分所反映的患者更高的等待名单优先级。我们旨在调查获得PELD/MELD例外的患者的等待名单结果。对18岁以下儿童进行了一项回顾性队列研究。使用单变量分析评估等待名单结果。从2005年7月到2014年1月，有408名儿童被列入肝移植等待名单。其中304名根据计算出的PELD/MELD进行了分类。在此期间，85名（30%）患者获得了PELD/MELD例外。在这个队列中，89.4%（85名中的76名）接受了移植，7.1%（85名中的6名）在等待名单上死亡。其余3名患者（3.5%）因其他原因从等待名单中移除。我们将这85名患者中PELD/MELD例外的影响与87名PELD/MELD≥19分的非例外患者的结果进行了比较。获得例外的患者获得等待名单的机会明显更好，等待名单死亡率更低。我们的数据表明，与具有同等PELD/MELD等待名单优先级的慢性肝病儿童相比，被列入PELD/MELD例外的儿童具有优势。
