Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Transplantation. 2022 Jul 1;106(7):1401-1410. doi: 10.1097/TP.0000000000004049. Epub 2022 Mar 24.
In the appropriate candidate, liver transplantation (LT) is a viable treatment for alcoholic hepatitis (AH). We compared the waitlisting trends and outcomes of AH patients in the context of others with high Model for End-stage Liver Disease (MELD) score.
LT listings for AH between January 1, 2008, and June 12, 2020 were identified in the United Network for Organ Sharing database. Temporal trends in listings for AH were assessed. Covariate adjusted competing risks models evaluated waitlist mortality and LT rates between AH candidates and others with listing native MELD ≥30.
Between 2008 and 2019, waitlist additions for AH increased 6.5-fold. Waiting time for AH candidates was short (median 10 d). Delisting for clinical improvement was infrequent in AH, albeit higher than MELD ≥30 patients (3.3% versus 0.8%; P < 0.001). Among 99 centers with ≥1 AH listing, AH patients accounted for 0.2%-18.2% of all alcohol-related listings and 0.6%-25.0% of those with native listing MELD ≥30. Overall listing volume was larger at these 99 centers than the 40 with no AH listings (P < 0.001). AH candidates in 2014-2020 experienced improved waitlist survival (adjusted subhazard ratio, 0.67; 95% confidence interval, 0.52-0.86; P = 0.002) and higher transplant rates (adjusted subhazard ratio, 1.14; 95% confidence interval, 1.04-1.25; P = 0.006) versus other MELD ≥30 candidates.
There has been a rising trend in waitlisting patients with AH and high MELD score. Liver disease causes influence waitlist outcomes and those of AH candidates are more favorable. Further research and allocation adjustments may be needed to ensure equitable organ allocation, based on liver disease cause, for those on the LT waitlist.
在合适的患者中，肝移植（LT）是治疗酒精性肝炎（AH）的可行方法。我们比较了在其他 MELD 评分较高的患者背景下，AH 患者的等待名单趋势和结果。
在 United Network for Organ Sharing 数据库中确定了 2008 年 1 月 1 日至 2020 年 6 月 12 日期间用于 AH 的 LT 名单。评估了 AH 名单的时间趋势。协变量调整的竞争风险模型评估了 AH 候选人和其他 MELD≥30 列表的等待名单死亡率和 LT 率之间的差异。
在 2008 年至 2019 年期间，AH 的等待名单增加了 6.5 倍。AH 候选者的等待时间很短（中位数为 10 天）。尽管 AH 患者的临床改善后除名率高于 MELD≥30 患者（3.3%比 0.8%；P<0.001），但这种情况并不常见。在 99 个有≥1 个 AH 名单的中心中，AH 患者占所有酒精相关名单的 0.2%-18.2%，占 MELD 固有列表≥30 的患者的 0.6%-25.0%。这些 99 个中心的总体名单量大于没有 AH 名单的 40 个中心（P<0.001）。2014 年至 2020 年，AH 候选者的等待名单生存率得到改善（调整后的亚危险比，0.67；95%置信区间，0.52-0.86；P=0.002），LT 移植率更高（调整后的亚危险比，1.14；95%置信区间，1.04-1.25；P=0.006），与其他 MELD≥30 候选者相比。
等待 AH 和高 MELD 评分患者的趋势呈上升趋势。肝病病因影响等待名单结果，AH 患者的结果更为有利。可能需要进一步的研究和分配调整，以确保根据 LT 等待名单上的肝病病因公平分配器官。
