Zhang Theodore, Dunson Jordan, Kanwal Fasiha, Galvan Nhu Thao Nguyen, Vierling John M, O'Mahony Christine, Goss John A, Rana Abbas
Department of Student Affairs, Baylor College of Medicine, Houston, Texas.
Michael E. DeBakey Department of Medicine, Baylor College of Medicine, Houston, Texas.
JAMA Surg. 2020 Aug 5;155(10):926-32. doi: 10.1001/jamasurg.2020.2484.
Investigating outcomes after marginal allograft transplant is essential in determining appropriate and more aggressive use of these allografts.
To determine the time trends in the outcomes of marginal liver allografts as defined by 6 different sets of criteria.
DESIGN, SETTING, AND PARTICIPANTS: In this case-control, multicenter study, 75 050 patients who received a liver transplant between March 1, 2002, and September 30, 2016, were retrospectively analyzed to last known follow-up (n = 55 395) or death (n = 19 655) using the United Network for Organ Sharing Database. The study period was divided into three 5-year eras: 2002-2006, 2007-2011, and 2012-2016. Kaplan-Meier survival analysis with log-rank test and Cox proportional hazards regression analysis were used to examine the allograft after transplant with marginal allografts, which were defined as 90th percentile Donor Risk Index allografts (calculated over the entire study period), donor after circulatory death allografts, national share allografts, old age (donors >70 years) allografts, fatty liver allografts, and 90th percentile Discard Risk Index allografts. Statistical analysis was performed from August to December 2019.
Allograft failure after transplant as defined by the Organ Procurement and Transplantation Network database.
Among the 75 050 patients (44 394 men; mean [SD] age, 54.3 [9.9] years) in the study, Donor Risk Index, patient Model for End-stage Liver Disease scores, and balance of risk scores significantly increased over time. Multivariate Cox proportional hazards regression analysis indicated that 90th percentile Donor Risk Index allograft survival increased across the study period (2002-2006: hazard ratio, 1.41 [95% CI, 1.34-1.49]; 2007-2011: hazard ratio, 1.25 [95% CI, 1.17-1.34]; 2012-2016: hazard ratio, 1.10 [95% CI, 0.98-1.24]). Secondary definitions of marginal allografts (donor after circulatory death, national share, old age donors, fatty liver, and 90th percentile Discard Risk Index) showed similar improvements in allograft survival.
The study's findings encourage the aggressive use of liver allografts and may indicate a need for a redefinition of allograft marginality in liver transplantation.
研究边缘性同种异体移植后的结果对于确定这些同种异体移植的适当且更积极的使用至关重要。
确定由6种不同标准定义的边缘性肝同种异体移植结果的时间趋势。
设计、设置和参与者：在这项病例对照多中心研究中，对2002年3月1日至2016年9月30日期间接受肝移植的75050名患者进行回顾性分析，使用器官共享联合网络数据库直至最后已知随访（n = 55395）或死亡（n = 19655）。研究期分为三个5年阶段：2002 - 2006年、2007 - 2011年和2012 - 2016年。采用Kaplan - Meier生存分析和对数秩检验以及Cox比例风险回归分析来检查移植后边缘性同种异体移植的同种异体移植物，边缘性同种异体移植定义为第90百分位数供体风险指数同种异体移植物（在整个研究期间计算）、循环死亡后供体同种异体移植物、全国分配同种异体移植物、老年（供体>70岁）同种异体移植物、脂肪肝同种异体移植物和第90百分位数废弃风险指数同种异体移植物。统计分析于2019年8月至12月进行。
器官获取与移植网络数据库定义的移植后同种异体移植物失败。
在该研究的75050名患者（44394名男性；平均[标准差]年龄，54.3[9.9]岁）中，供体风险指数、终末期肝病患者模型评分和风险评分平衡随时间显著增加。多变量Cox比例风险回归分析表明，第90百分位数供体风险指数同种异体移植物的生存率在整个研究期间有所提高（2002 - 2006年：风险比，1.41[95%置信区间，1.34 - 1.49]；2007 - 2011年：风险比，1.25[95%置信区间，1.17 - 1.34]；2012 - 2016年：风险比，1.10[95%置信区间,0.98 - 1.24]）。边缘性同种异体移植的次要定义（循环死亡后供体、全国分配、老年供体、脂肪肝和第90百分位数废弃风险指数）显示同种异体移植物生存率有类似改善。
该研究结果鼓励积极使用肝同种异体移植物，并可能表明需要重新定义肝移植中同种异体移植物的边缘性。
