Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA.
Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.
Am J Transplant. 2021 Feb;21 Suppl 2:208-315. doi: 10.1111/ajt.16494.
This year was notable for changes to exception points determined by the geographic median allocation Model for End-Stage Liver Disease (MELD) and implementation of the National Liver Review Board, which took place on May 14, 2019. The national acuity circle liver distribution policy was also implemented but reverted to donor service area- and region-based boundaries after 1 week. In 2019, growth continued in the number of new waiting list registrations (12,767) and transplants performed (8,896), including living-donor transplants (524). Compared with 2018, living-donor liver transplants increased 31%. Women continued to have a lower deceased-donor transplant rate and a higher pretransplant mortality rate than men. The median waiting time for candidates with a MELD of 15-34 decreased, while the number of transplants performed for patients with exception points decreased. These changes may have been related to the policy changes that took effect in May 2019, which increased waiting list priority for candidates without exception status. Hepatitis C continued to decline as an indication for liver transplant, as the proportion of liver transplant recipients with alcohol-related liver disease and clinical profiles consistent with non-alcoholic steatohepatitis increased. Graft and patient survival have improved despite changing recipient demographics including older age, higher MELD, and higher prevalence of obesity and diabetes.
今年值得注意的变化包括地理中位数分配模型（MELD）决定的例外点和国家肝脏审查委员会的实施，该委员会于 2019 年 5 月 14 日成立。全国急性肝脏分配政策也已实施，但在 1 周后又恢复到基于供体服务区和区域的边界。2019 年，新的等待名单注册人数（12767 人）和移植手术数量（8896 人）持续增长，包括活体供体移植（524 人）。与 2018 年相比，活体供体肝移植增加了 31%。与男性相比，女性的已故供体移植率仍然较低，移植前死亡率较高。MELD 为 15-34 的候选者的等待时间中位数减少，而例外点患者的移植数量减少。这些变化可能与 2019 年 5 月生效的政策变化有关，该政策增加了无例外状态的候选者在等待名单上的优先级。由于酒精性肝病和非酒精性脂肪性肝炎患者比例增加，丙型肝炎继续作为肝移植的指征下降。尽管受者人口统计学特征发生变化，包括年龄较大、MELD 较高以及肥胖和糖尿病的发病率较高，但移植物和患者的存活率有所提高。
