Eurotransplant International Foundation, Leiden, The Netherlands.
Division of Transplantation, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Transplantation. 2019 Jun;103(6):1181-1190. doi: 10.1097/TP.0000000000002526.
About 15% of liver transplantations (LTs) in Eurotransplant are currently performed in patients with a high-urgency (HU) status. Patients who have acute liver failure (ALF) or require an acute retransplantation can apply for this status. This study aims to evaluate the efficacy of this prioritization.
Patients who were listed for LT with HU status from January 1, 2007, up to December 31, 2015, were included. Waiting list and posttransplantation outcomes were evaluated and compared with a reference group of patients with laboratory Model for End-Stage Liver Disease (MELD) score (labMELD) scores ≥40 (MELD 40+).
In the study period, 2299 HU patients were listed for LT. Ten days after listing, 72% of all HU patients were transplanted and 14% of patients deceased. Patients with HU status for primary ALF showed better patient survival at 3 years (69%) when compared with patients in the MELD 40+ group (57%). HU patients with labMELD ≥45 and patients with HU status for acute retransplantation and labMELD ≥35 have significantly inferior survival at 3-year follow-up of 46% and 42%, respectively.
Current prioritization for patients with ALF is highly effective in preventing mortality on the waiting list. Although patients with HU status for ALF have good outcomes, survival is significantly inferior for patients with a high MELD score or for retransplantations. With the current scarcity of livers in mind, we should discuss whether potential recipients for a second or even third retransplantation should still receive absolute priority, with HU status, over other recipients with an expected, substantially better prognosis after transplantation.
在 Eurotransplant 进行的大约 15%的肝移植（LT）目前用于高紧急（HU）状态的患者。患有急性肝衰竭（ALF）或需要急性再次移植的患者可以申请此状态。本研究旨在评估这种优先级排序的效果。
从 2007 年 1 月 1 日至 2015 年 12 月 31 日，将列入 LT 清单并具有 HU 状态的患者纳入研究。评估等待名单和移植后结果，并与实验室终末期肝病模型（MELD）评分（labMELD）≥40 分（MELD40+）的参考组患者进行比较。
在研究期间，2299 名 HU 患者被列入 LT 清单。列入清单后 10 天，72%的所有 HU 患者接受了移植，14%的患者死亡。HU 状态为原发性 ALF 的患者在 3 年时的患者生存率（69%）明显优于 MELD40+组（57%）。HU 状态为 labMELD≥45 且 HU 状态为急性再次移植且 labMELD≥35 的患者在 3 年随访中生存率分别为 46%和 42%，明显较差。
目前针对 ALF 患者的优先级排序在防止等待名单上的死亡率方面非常有效。尽管 HU 状态为 ALF 的患者的结果较好，但对于 MELD 评分较高的患者或再次移植的患者，生存率明显较差。考虑到目前肝脏短缺的情况，我们应该讨论是否应该仍然给予具有潜在接受第二次甚至第三次再次移植的患者绝对优先级，而 HU 状态使其在移植后具有明显更好的预后的其他接受者优先。
