Latt Nyan L, Niazi Mumtaz, Pyrsopoulos Nikolaos T
Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ 07101-1709, United States.
World J Methodol. 2022 Jan 20;12(1):32-42. doi: 10.5662/wjm.v12.i1.32.
Liver transplant allocation policies in the United States has evolved over 3 decades. The donor liver organs are matched, allocated and procured by the Organ Procurement and Transplantation Network which is administered by the United Network of Organ Sharing (UNOS), a not-for-profit organization governed by the United States human health services. We reviewed the evolution of liver transplant allocation policies. Prior to 2002, UNOS used Child-Turcotte-Pugh score to list and stratify patients for liver transplantation (LT). After 2002, UNOS changed its allocation policy based on model for end-stage liver disease (MELD) score. The serum sodium is the independent indicator of mortality risk in patients with chronic liver disease. The priority assignment of MELD-sodium score resulted in LT and prevented mortality on waitlist. MELD-Sodium score was implemented for liver allocation policy in 2016. Prior to the current and most recent policy, livers from adult donors were matched first to the status 1A/1B patients located within the boundaries of the UNOS regions and donor-service areas (DSA). We reviewed the disadvantages of the DSA-based allocation policies and the advantages of the newest acuity circle allocation model. We then reviewed the standard and non-standard indications for MELD exceptions and the decision-making process of the National Review Liver Review Board. Finally, we reviewed the liver transplant waitlist, donation and survival outcomes in the United States.
美国的肝移植分配政策在过去30多年里不断演变。供体肝脏器官由器官获取与移植网络进行匹配、分配和获取，该网络由器官共享联合网络（UNOS）管理，UNOS是一个由美国人类健康服务部门管理的非营利组织。我们回顾了肝移植分配政策的演变。2002年之前，UNOS使用Child-Turcotte-Pugh评分对肝移植患者进行排队和分层。2002年之后，UNOS根据终末期肝病模型（MELD）评分改变了其分配政策。血清钠是慢性肝病患者死亡风险的独立指标。MELD-钠评分的优先分配导致了肝移植并降低了等待名单上的死亡率。MELD-钠评分于2016年应用于肝脏分配政策。在当前和最新政策之前，成年供体的肝脏首先与位于UNOS区域和供体服务区域（DSA）范围内的1A/1B级患者进行匹配。我们回顾了基于DSA的分配政策的缺点和最新的急性病区域分配模型的优点。然后，我们回顾了MELD例外情况的标准和非标准适应症以及国家肝脏评审委员会的决策过程。最后，我们回顾了美国的肝移植等待名单、捐赠情况和生存结果。
