Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Liver Transpl. 2020 May;26(5):628-639. doi: 10.1002/lt.25748.
In contrast to donor factors predicting outcomes of liver transplantation (LT), few suitable recipient parameters have been identified. To this end, we performed an in-depth analysis of hospitalization status and duration prior to LT as a potential risk factor for posttransplant outcome. The pretransplant hospitalization status of all patients undergoing LT between 2005 and 2016 at the Charité-Universitätsmedizin Berlin was analyzed retrospectively using propensity score matching. At the time of organ acceptance, 226 of 1134 (19.9%) recipients were hospitalized in an intensive care unit (ICU), 146 (12.9%) in a regular ward (RW) and 762 patients (67.2%) were at home. Hospitalized patients (RW and ICU) compared with patients from home showed a dramatically shorter 3-month survival (78.7% versus 94.4%), 1-year survival (66.3% versus 87.3%), and 3-year survival (61.7% versus 81.7%; all P < 0.001), whereas no significant difference was detected for 3-year survival between ICU and RW patients (61.5% versus 62.3%; P = 0.60). These results remained significant after propensity score matching. Furthermore, in ICU patients, but not in RW patients, survival correlated with days spent in the ICU before LT (1-year survival: 1-6 versus 7-14 days: 73.7% versus 60.5%, P = 0.04; 7-14 days versus >14 days, 60.5% versus 51.0%, P = 0.006). In conclusion, hospitalization status before transplantation is a valuable predictor of patient survival following LT.
与预测肝移植 (LT) 结局的供体因素相比，很少有合适的受体参数被确定。为此，我们对 LT 前的住院状态和时间进行了深入分析，将其作为移植后结局的潜在风险因素。使用倾向评分匹配法，回顾性分析了 2005 年至 2016 年期间在柏林夏里特医科大学接受 LT 的所有患者的移植前住院状态。在器官接受时，1134 例患者中有 226 例（19.9%）住院于重症监护病房（ICU），146 例（12.9%）住院于普通病房（RW），762 例患者（67.2%）在家中。与在家中的患者相比，住院患者（RW 和 ICU）的 3 个月生存率（78.7%对 94.4%）、1 年生存率（66.3%对 87.3%）和 3 年生存率（61.7%对 81.7%）显著降低（均 P<0.001），而 ICU 和 RW 患者的 3 年生存率无显著差异（61.5%对 62.3%；P=0.60）。在倾向评分匹配后，这些结果仍然具有统计学意义。此外，在 ICU 患者中，而不是在 RW 患者中，生存与 LT 前在 ICU 中度过的天数相关（1 年生存率：1-6 天对 7-14 天：73.7%对 60.5%，P=0.04；7-14 天对>14 天：60.5%对 51.0%，P=0.006）。总之，移植前的住院状态是 LT 后患者生存的一个有价值的预测因素。
