Husen Peri, Hornung Julian, Benko Tamas, Klein Christian, Willuweit Katharina, Buechter Matthias, Saner Fuat Hakan, Paul Andreas, Treckmann Juergen Walter, Hoyer Dieter Paul
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Ann Transplant. 2019 May 3;24:242-251. doi: 10.12659/AOT.914246.
BACKGROUND Germany has the highest rate of patients dying or becoming unfit for transplant while waitlisted within the Eurotransplant region. Therefore, the aim of the current study was to analyze mortality as well as risk factors for mortality of candidates listed for liver transplantation at our center. MATERIAL AND METHODS Between 01/2011 and 12/2013, 481 adult patients were listed for primary liver transplantation (LT) at a single German center. Clinical and laboratory parameters were prospectively collected and retrospectively analyzed by univariable and multivariable logistic regression and Cox proportional hazards. RESULTS The mean model for end-stage liver disease (MELD) score of all liver transplant waitlist registrants (52.4 years, 60.1% male) was 16.9 (±10.2) at time of listing, with 10% of the listed patients having a MELD score of >32. After waitlisting, 133 (27.7%) candidates died within the follow-up period. Three-month-survival after listing for transplantation was 89% for patients ultimately receiving LT vs. 71.2% that did not receive LT (p<0.001). Multivariable analysis identified clinical parameters such as ICU treatment, preceding abdominal surgery, variceal bleeding, and ascites, as well as hydropic decompensation, as independent risk factors for waitlist mortality. CONCLUSIONS Consideration of independent risk factors of mortality within the MELD-based allocation system potentially improves assessment of individual urgency and might improve utilization of available organs.
背景 在欧洲移植区域内，德国等待移植的患者死亡率或不再适合移植的比例最高。因此，本研究的目的是分析我院中心等待肝移植患者的死亡率及其死亡风险因素。材料与方法 2011年1月至2013年12月期间，德国一家中心有481例成年患者被列入首次肝移植（LT）名单。前瞻性收集临床和实验室参数，并通过单变量和多变量逻辑回归以及Cox比例风险模型进行回顾性分析。结果 所有等待肝移植登记患者（52.4岁，60.1%为男性）在列入名单时的终末期肝病平均模型（MELD）评分为16.9（±10.2），其中10%的列入名单患者MELD评分>32。列入名单后，133例（27.7%）候选者在随访期内死亡。最终接受肝移植的患者移植列入名单后三个月生存率为89%，未接受肝移植的患者为71.2%（p<0.001）。多变量分析确定了诸如重症监护病房治疗、先前腹部手术、静脉曲张出血和腹水以及水肿性失代偿等临床参数为等待名单死亡率的独立风险因素。结论 在基于MELD的分配系统中考虑死亡率的独立风险因素可能会改善对个体紧迫性的评估，并可能提高可用器官的利用率。
