Cotter Thomas G, Sandıkçı Burhaneddin, Paul Sonali, Gampa Anuhya, Wang Jennifer, Te Helen, Pillai Anjana, Reddy Kapuluru G, di Sabato Diego, Little Ester C, Sundaram Vinay, Fung John, Lucey Michael R, Charlton Michael
Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois.
Booth School of Business, University of Chicago, Chicago, Illinois.
Am J Transplant. 2021 Mar;21(3):1039-1055. doi: 10.1111/ajt.16143. Epub 2020 Aug 13.
Medical-refractory severe alcoholic hepatitis (AH) has a high mortality. The national frequency, longer term outcomes and regional practices of AH liver transplantation (LT) in the United States are not well described, despite the increasing mortality from alcohol-associated liver disease. We analyzed the trends in frequency and outcomes of UNOS data on 39 455 adult patients who underwent LT from 2014 to 2019, including AH LT recipients. LTs for AH increased 5-fold, from 28 in 2014 to 138 in 2019, varying 8-fold between UNOS regions. Three transplant centers accounted for 50%-90% of AH LTs within each region. The number of transplant centers performing AH LTs increased from 14 in 2014 to 47 in 2019. AH patients were younger (mean = 39.4 years), had higher MELD scores (mean = 36.8), and were more often on dialysis (46.0%) and in ICU (38.4%), compared to other indications (all P < .05). One- and 5-year graft survivals for AH LT recipients were 91.7% and 81.9%, respectively. The frequency of AH LT is increasing rapidly, with excellent medium-term outcomes. An impact of AH recurrence on patient or graft survival is not apparent in this national analysis. There are marked geographic variations in practices, highlighting the lack of selection criteria standardization.
药物难治性重症酒精性肝炎（AH）死亡率很高。尽管酒精性肝病导致的死亡率不断上升，但美国AH肝移植（LT）的全国发病率、长期预后及地区实践情况仍未得到充分描述。我们分析了2014年至2019年接受LT的39455名成年患者（包括AH LT受者）的器官共享联合网络（UNOS）数据的发病率及预后趋势。AH的LT数量增加了5倍，从2014年的28例增至2019年的138例，在UNOS各地区之间相差8倍。每个地区内，三个移植中心进行的AH LT占50%-90%。进行AH LT的移植中心数量从2014年的14个增至2019年的47个。与其他适应症相比，AH患者更年轻（平均39.4岁），终末期肝病模型（MELD）评分更高（平均36.8），且更常接受透析（46.0%）和入住重症监护病房（ICU，38.4%）（所有P<0.05）。AH LT受者的1年和5年移植物存活率分别为91.7%和81.9%。AH LT的发病率正在迅速上升，中期预后良好。在这项全国性分析中，AH复发对患者或移植物存活的影响并不明显。实践中存在明显的地域差异突出了选择标准缺乏标准化这一问题。
