酒精性肝病患者在进行肝移植登记时的功能状态更差，在等待移植名单上和移植后死亡率更高，而年龄较大则使情况更加复杂。
Patients with Alcoholic Liver Disease Have Worse Functional Status at Time of Liver Transplant Registration and Greater Waitlist and Post-transplant Mortality Which Is Compounded by Older Age.
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA.
Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA.
出版信息
Dig Dis Sci. 2020 May;65(5):1501-1511. doi: 10.1007/s10620-019-05891-1. Epub 2019 Oct 22.
BACKGROUND
Worse functional status correlates with increased mortality on the liver transplant (LT) waitlist. Whether functional status affects LT outcomes equally across cirrhosis etiologies is unclear.
AIMS
We evaluate the impact of functional status on waitlist and post-LT mortality stratified by etiology and age.
METHODS
Functional status among US adults from 2005 to 2017 United Network for Organ Sharing LT registry data was retrospectively evaluated using Karnofsky Performance Status Score (KPS-1 = functional status 80-100%, KPS-2 = 60-70%, KPS-3 = 40-50%, KPS-4 = 10-30%). Waitlist and post-LT survival were stratified by KPS and cirrhosis etiology, including alcoholic liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis C (HCV), and HCV/ALD, and evaluated using Kaplan-Meier and multivariate Cox proportional hazard models.
RESULTS
Among 94,201 waitlist registrants (69.4% men, 39.5% HCV, 26.7% ALD, 23.2% NASH), ALD patients had worse functional status compared to HCV (KPS-4: 17.2% vs. 8.3%, p < 0.001). Worse functional status at time of waitlist registration was associated with higher 90-day waitlist mortality with the greatest effect in ALD (KPS-4 vs. KPS-1: ALD HR 2.16, 95% CI 1.83-2.55; HCV HR 2.17, 95% CI 1.87-2.51). Similar trends occurred in 5-year post-LT survival with ALD patients the most harmed. Compared to patients < 50 years, patients ≥ 65 years had increased waitlist mortality at 90-days if they had HCV or HCV/ALD, and 5-year post-LT mortality regardless of cirrhosis etiology with ALD patients most severely affected.
CONCLUSIONS
In a retrospective cohort study of patients, US ALD patients had disparately worse functional status at time of LT waitlist registration. Worse functional status correlated with higher risk of waitlist and post-LT mortality, affecting ALD and HCV patients the most.
背景
肝功能状态越差，肝移植（LT）等待名单上的死亡率就越高。但肝功能状态是否会对不同病因的 LT 结果产生同样的影响还不清楚。
目的
我们评估了功能状态对病因和年龄分层的等待名单和 post-LT 死亡率的影响。
方法
使用 Karnofsky 表现状态评分（KPS-1=功能状态 80-100%，KPS-2=60-70%，KPS-3=40-50%，KPS-4=10-30%），回顾性评估了 2005 年至 2017 年美国器官共享网络 LT 注册数据中成年人的功能状态。根据 KPS 和肝硬化病因（包括酒精性肝病 [ALD]、非酒精性脂肪性肝炎 [NASH]、丙型肝炎 [HCV]和 HCV/ALD）对等待名单和 post-LT 生存情况进行分层，并使用 Kaplan-Meier 和多变量 Cox 比例风险模型进行评估。
结果
在 94201 名等待名单登记患者中（69.4%为男性，39.5%为 HCV，26.7%为 ALD，23.2%为 NASH），ALD 患者的功能状态比 HCV 患者差（KPS-4：17.2%比 8.3%，p<0.001）。等待名单登记时功能状态较差与 90 天等待名单死亡率较高相关，ALD 患者的影响最大（KPS-4 比 KPS-1：ALD HR 2.16，95%CI 1.83-2.55；HCV HR 2.17，95%CI 1.87-2.51）。5 年 post-LT 生存率也出现了类似的趋势，ALD 患者受到的伤害最大。与<50 岁的患者相比，如果≥65 岁的患者患有 HCV 或 HCV/ALD，则在 90 天内等待名单死亡率增加，而无论肝硬化病因如何，5 年 post-LT 死亡率均增加，其中 ALD 患者受影响最大。
结论
在一项对患者的回顾性队列研究中，美国 ALD 患者在 LT 等待名单登记时的功能状态明显较差。功能状态越差，等待名单和 post-LT 死亡率的风险越高，对 ALD 和 HCV 患者的影响最大。
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