肝移植适应证：过去十年帕拉纳州 1706 例肝切除术分析。
INDICATION FOR LIVER TRANSPLANTATION DUE TO HEPATOCELLULAR CARCINOMA: ANALYSIS OF 1,706 PROCEDURES OVER THE PAST DECADE IN THE STATE OF PARANÁ.
机构信息
Universidade Federal do Paraná, Department of Surgery and Liver Transplant Unit - Curitiba (PR), Brazil.
出版信息
Arq Bras Cir Dig. 2022 Dec 19;35:e1701. doi: 10.1590/0102-672020220002e1701. eCollection 2022.
BACKGROUND
Patients listed for liver transplantation and hepatocellular carcinoma are considered priority on the waiting list, and this could overly favor them.
AIM
This study aimed to evaluate the impact of this prioritization.
METHODS
We analyzed the liver transplants performed in adults from 2011 to 2020 and divided into three groups: adjusted Model of End-Stage Liver Disease (MELD) score for hepatocellular carcinoma, other adjusted Model of End-Stage Liver Disease situations, and no adjusted Model of End-Stage Liver Disease.
RESULTS
A total of 1,706 patients were included in the study, of which 70.2% were male. Alcoholism was the main etiology of cirrhosis (29.6%). Of the total, 305 patients were with hepatocellular carcinoma, 86 with other adjusted Model of End-Stage Liver Disease situations, and 1,315 with no adjusted Model of End-Stage Liver Disease. Patients with hepatocellular carcinoma were older (58.9 vs. 53.5 years). The predominant etiology of cirrhosis was viral hepatitis (60%). The findings showed that group with adjusted Model of End-Stage Liver Disease had lower physiological Model of End-Stage Liver Disease (10.9), higher adjusted Model of End-Stage Liver Disease (22.6), and longer waiting list time (131 vs. 110 days), as compared to the group with no adjusted Model of End-Stage Liver Disease. The total number of transplants and the proportion of patients transplanted for hepatocellular carcinoma increased from 2011 to 2020. There was a reduction in the proportion of patients with hepatocellular carcinoma and adjusted Model of End-Stage Liver Disease of 20 and there was an increase on waiting list time in this group. There was an increase in the proportion of those with adjusted Model of End-Stage Liver Disease of 24 and 29, but the waiting list time remained stable.
CONCLUSION
Over the past decade, prioritization of hepatocellular carcinoma resulted in an increased proportion of transplanted patients in relation to those with no priority. It also increased waiting list time, requiring higher adjusted Model of End-Stage Liver Disease to transplant an organ.
背景
接受肝移植和肝细胞癌治疗的患者在等待名单上被视为优先考虑对象，这可能会过度优待他们。
目的
本研究旨在评估这种优先排序的影响。
方法
我们分析了 2011 年至 2020 年期间进行的成人肝移植，并将其分为三组：调整后的终末期肝病模型（MELD）评分用于肝细胞癌、其他调整后的终末期肝病情况和未调整后的终末期肝病。
结果
共纳入 1706 例患者，其中 70.2%为男性。酒精性肝硬化是最主要的病因（29.6%）。在总数中，有 305 例患有肝细胞癌，86 例患有其他调整后的终末期肝病情况，1315 例患有未调整后的终末期肝病。患有肝细胞癌的患者年龄较大（58.9 岁比 53.5 岁）。肝硬化的主要病因是病毒性肝炎（60%）。研究结果表明，调整后的终末期肝病模型组的生理终末期肝病模型评分较低（10.9），调整后的终末期肝病模型评分较高（22.6），等待名单时间较长（131 天比 110 天），与未调整后的终末期肝病模型组相比。2011 年至 2020 年，接受肝移植的总人数和因肝细胞癌接受移植的患者比例有所增加。患有肝细胞癌和调整后的终末期肝病模型的患者比例分别减少了 20%，且该组的等待名单时间有所增加。患有调整后的终末期肝病模型的患者比例分别增加了 24%和 29%，但等待名单时间保持稳定。
结论
在过去的十年中，对肝细胞癌的优先排序导致优先考虑的患者比例增加，而等待名单时间也增加，需要更高的调整后的终末期肝病模型评分才能进行器官移植。
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