Yoo Seung Yeon, Kim Gaab Soo
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Anesth Pain Med (Seoul). 2021 Jan;16(1):68-74. doi: 10.17085/apm.20035. Epub 2021 Jan 25.
The allocation policy for deceased donor livers in Korea was changed in June 2016 from Child-Turcotte-Pugh (CTP) scoring system-based to Model for End-stage Liver Disease (MELD) scoring system-based. Thus, it is necessary to review the effect of allocation policy changes on anesthetic management.
Medical records of deceased donor liver transplantation (DDLT) from December 2014 to May 2017 were reviewed. We compared the perioperative parameters before and after the change in allocation policy.
Thirty-seven patients underwent DDLT from December 2014 to May 2016 (CTP group), and 42 patients underwent DDLT from June 2016 to May 2017 (MELD group). The MELD score was significantly higher in the MELD group than in the CTP group (36.5 ± 4.6 vs. 26.5 ± 9.4, P < 0.001). The incidence of hepatorenal syndrome was higher in the MELD group than in the CTP group (26 vs. 7, P < 0.001). Packed red blood cell transfusion occurred more frequently in the MELD group than in the CTP group (5.0 ± 3.6 units vs. 3.4 ± 2.2 units, P = 0.025). However, intraoperative bleeding, vasopressor support, and postoperative outcomes were not different between the two groups.
Even though the patient's objective condition deteriorated, perioperative parameters did not change significantly.
韩国已故供体肝脏的分配政策于2016年6月从基于Child-Turcotte-Pugh（CTP）评分系统改为基于终末期肝病模型（MELD）评分系统。因此，有必要回顾分配政策变化对麻醉管理的影响。
回顾了2014年12月至2017年5月已故供体肝移植（DDLT）的病历。我们比较了分配政策改变前后的围手术期参数。
2014年12月至2016年5月有37例患者接受了DDLT（CTP组），2016年6月至2017年5月有42例患者接受了DDLT（MELD组）。MELD组的MELD评分显著高于CTP组（36.5±4.6对26.5±9.4，P<0.001）。MELD组肝肾综合征的发生率高于CTP组（26例对7例，P<0.001）。MELD组浓缩红细胞输注比CTP组更频繁（5.0±3.6单位对3.4±2.2单位，P=0.025）。然而，两组之间的术中出血、血管活性药物支持和术后结果并无差异。
尽管患者的客观状况恶化，但围手术期参数并未显著改变。
