Ivanics Tommy, Vianna Rodrigo, Kubal Chandrashekhar A, Iyer Kishore R, Mazariegos George V, Matsumoto Cal S, Mangus Richard, Beduschi Thiago, Abouljoud Marwan, Fridell Jonathan A, Nagai Shunji
Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Michigan, USA.
Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
Am J Transplant. 2022 Feb;22(2):464-473. doi: 10.1111/ajt.16803. Epub 2021 Aug 26.
Liver allocation was updated on February 4, 2020, replacing a Donor Service Area (DSA) with acuity circles (AC). The impact on waitlist outcomes for patients listed for combined liver-intestine transplantation (multivisceral transplantation [MVT]) remains unknown. The Organ Procurement and Transplantation Network/United Network for Organ Sharing database was used to identify all candidates listed for both liver and intestine between January 1, 2018 and March 5, 2021. Two eras were defined: pre-AC (2018-2020) and post-AC (2020-2021). Outcomes included 90-day waitlist mortality and transplant probability. A total of 127 adult and 104 pediatric MVT listings were identified. In adults, the 90-day waitlist mortality was not statistically significantly different, but transplant probability was lower post-AC. After risk-adjustment, post-AC was associated with a higher albeit not statistically significantly different mortality hazard (sub-distribution hazard ratio[sHR]: 8.45, 95% CI: 0.96-74.05; p = .054), but a significantly lower transplant probability (sHR: 0.33, 95% CI: 0.15-0.75; p = .008). For pediatric patients, waitlist mortality and transplant probability were similar between eras. The proportion of patients who underwent transplant with exception points was lower post-AC both in adult (44% to 9%; p = .04) and pediatric recipients (65% to 15%; p = .002). A lower transplant probability observed in adults listed for MVT may ultimately result in increased waitlist mortality. Efforts should be taken to ensure equitable organ allocation in this vulnerable patient population.
肝脏分配于2020年2月4日更新，用 acuity circles（AC）取代了捐赠服务区（DSA）。对于联合肝脏-肠道移植（多脏器移植 [MVT]）登记患者的等待名单结果的影响仍不清楚。器官获取与移植网络/器官共享联合网络数据库用于识别2018年1月1日至2021年3月5日期间所有登记肝脏和肠道移植的候选人。定义了两个时期：AC前（2018 - 2020年）和AC后（2020 - 2021年）。结果包括90天等待名单死亡率和移植概率。共识别出127例成人和104例儿科MVT登记。在成人中，90天等待名单死亡率无统计学显著差异，但AC后移植概率较低。风险调整后，AC后与更高的死亡率风险相关，尽管无统计学显著差异（亚分布风险比 [sHR]：8.45，95%置信区间：0.96 - 74.05；p = 0.054），但移植概率显著更低（sHR：0.33，95%置信区间：0.15 - 0.75；p = 0.008）。对于儿科患者，不同时期的等待名单死亡率和移植概率相似。使用例外点进行移植的患者比例在AC后成人（从44%降至9%；p = 0.04）和儿科受者（从65%降至15%；p = 0.002）中均较低。在登记MVT的成人中观察到的较低移植概率最终可能导致等待名单死亡率增加。应努力确保在这一脆弱患者群体中实现公平的器官分配。
