身高较矮与肝癌患者接受肝移植的可能性较低相关。

Shorter Height Is Associated With Lower Probability of Liver Transplantation in Patients With Hepatocellular Carcinoma.

机构信息

Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA.

Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, CA.

出版信息

Transplantation. 2020 May;104(5):988-995. doi: 10.1097/TP.0000000000002975.

DOI:10.1097/TP.0000000000002975

PMID:31577670

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7935067/

Abstract

BACKGROUND

The effect of height and sex on liver transplantation (LT) for hepatocellular carcinoma (HCC) remains unclear.

METHODS

Using United Network for Organ Sharing (UNOS) data, 14 844 HCC patients listed for LT from 2005 to 2015 were identified. Cumulative incidence of waitlist events (LT and dropout for death or too sick) were calculated and modeled using Fine and Gray competing risk regression.

RESULTS

Short (SWR), mid (MWR), and long (LWR) UNOS wait regions comprised 25%, 42%, and 33% of the cohort. Three-year cumulative incidence of LT was lower in shorter height patients (≤150, 151-165, and >185 cm; 70.8%, 76.7%, and 83.5%; P < 0.001) and women (78.2% versus 79.8%; P < 0.001). On multivariable analysis, shorter height (≤150, 151-165 cm, hazard ratio [HR] versus >185 cm) was associated with lower probability of LT (0.81 and 0.89; P = 0.02) and greater dropout (HR 1.99 and 1.43; P < 0.001). Female sex was not associated with LT overall, but a significant sex and wait region interaction (P = 0.006) identified lower LT probability for women in MWR (HR versus men, 0.91; P = 0.02).

CONCLUSIONS

Despite uniform HCC Model for End-Stage Liver Disease exception across height and sex, shorter patients and females in MWR have lower probability of LT. Consideration should be given to awarding additional Model for End-Stage Liver Disease exception points to these patients.

摘要

背景

身高和性别对肝细胞癌（HCC）肝移植（LT）的影响尚不清楚。

方法

使用美国器官共享联合网络（UNOS）数据，确定了 2005 年至 2015 年期间 14844 名 HCC 患者接受 LT 的名单。使用 Fine 和 Gray 竞争风险回归计算并建模等待名单事件（LT 和因死亡或病入膏肓而退出）的累积发生率。

结果

短（SWR）、中（MWR）和长（LWR）UNOS 等待区分别占队列的 25%、42%和 33%。身高较短的患者（≤150、151-165 和>185cm）LT 的三年累积发生率较低（70.8%、76.7%和 83.5%；P<0.001）和女性（78.2%比 79.8%；P<0.001）。多变量分析显示，身高较矮（≤150、151-165cm，风险比[HR]与>185cm）与 LT 的可能性较低（0.81 和 0.89；P=0.02）和更大的脱落（HR 1.99 和 1.43；P<0.001）相关。女性性别总体上与 LT 无关，但性别和等待区的显著相互作用（P=0.006）确定了 MWR 中女性 LT 的可能性较低（HR 与男性相比，0.91；P=0.02）。