Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany; Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, 53127 Bonn, Germany.
Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany; Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, 53127 Bonn, Germany.
Dig Liver Dis. 2022 Jun;54(6):784-790. doi: 10.1016/j.dld.2021.12.011. Epub 2022 Jan 5.
Patients with acute-on-chronic liver failure (ACLF) show excess mortality in MELD-Na based organ allocation for liver transplantation (LT). Whether MELD-based allocation in the Eurotransplant region similarly underprioritizes ACLF patients is unknown.
428 patients listed for LT from 01/2010 to 02/2021 at a tertiary center in Germany were screened and 209 patients included as derivation (n = 123) and validation cohort (n = 86). Competing risk analysis for waitlist mortality and LT as competing events was performed.
90-day waitlist mortality for patients with MELD < and ≥ 25 at baseline was 9% vs. 33%, respectively (p = 0.009). Competing risk analysis shows significantly higher 90-day waitlist mortality in patients listed with ACLF compared to those without ACLF (p = 0.021) in the low MELD stratum. Probability of LT was similar between the two groups (p = 0.91). In the high MELD group, 90-day waitlist mortality and rates of LT were not significantly different between patients with and without ACLF (31% vs. 20%, p = 0.55 and 59% vs. 60%, p = 0.72, respectively). Post-transplant survival was similar between patients with and without ACLF. This result was confirmed in the validation cohort.
MELD-based organ allocation in the Eurotransplant region underestimates waitlist mortality in patients with ACLF in lower MELD ranges.
慢加急性肝衰竭（ACLF）患者在基于 MELD-Na 的肝移植（LT）器官分配中死亡率过高。在欧洲器官移植区域，MELD 基础分配是否同样优先考虑 ACLF 患者尚不清楚。
在德国的一家三级中心，对 2010 年 1 月至 2021 年 2 月期间接受 LT 治疗的 428 名患者进行了筛查，其中 209 名患者被纳入推导队列（n=123）和验证队列（n=86）。对等待名单死亡率和 LT 作为竞争事件的竞争风险分析进行了。
基线 MELD <25 和 ≥25 的患者 90 天等待名单死亡率分别为 9%和 33%（p=0.009）。竞争风险分析显示，在低 MELD 分层中，与无 ACLF 的患者相比，患有 ACLF 的患者在等待名单上的 90 天等待名单死亡率显著更高（p=0.021）。两组之间 LT 的概率相似（p=0.91）。在高 MELD 组中，患有和不患有 ACLF 的患者之间 90 天等待名单死亡率和 LT 率没有显著差异（31%比 20%，p=0.55 和 59%比 60%，p=0.72）。移植后生存情况在患有和不患有 ACLF 的患者之间相似。该结果在验证队列中得到了证实。
在欧洲器官移植区域，基于 MELD 的器官分配低估了低 MELD 范围内 ACLF 患者的等待名单死亡率。
