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肝移植后再次肝移植:时机同样重要。

Liver retransplantation: Timing is equally important.

机构信息

Liver Transplantation Center, Clinical Research Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Department of Hepatobiliary Surgery, Chifeng Municipal Hospital, Chifeng, China.

出版信息

Medicine (Baltimore). 2023 Sep 15;102(37):e35165. doi: 10.1097/MD.0000000000035165.

DOI:10.1097/MD.0000000000035165
PMID:37713841
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10508473/
Abstract

BACKGROUND AND AIM

To evaluate the effect of transplantation interval on patient and graft survival in liver retransplantation (reLT) using meta-analytical techniques.

METHODS

Literature search was undertaken until January 2022 to identify comparative studies evaluating patient survival rates, graft survival rates, and the interval time. Pooled hazard ratio (HR) or risk ratio (RR) and 95% confidence intervals (95% CI) were calculated with either the fixed or random effect model.

RESULTS

The 12 articles were included in this meta-analysis. The late reLT survival rate is better than the early reLT in the 30 days group, and there is no statistical significance in other time groups. The patient survival was significantly higher in late reLT than early reLT at 1 and 5 years (respectively: RR, 0.81 [95% CI, 0.73-0.89]; RR, 0.64 [95% CI, 0.46-0.88]). The graft survival was significantly higher in late reLT than early reLT at 1 year (RR, 0.75 [95% CI, 0.63-0.89]). The risk of death after reLT in early group was 1.43 times higher than that in late group (HR, 1.43 [95% CI, 1.21-1.71]).

CONCLUSIONS

Late reLT had significantly better survival rates than early reLT, and the transplantation interval was more reasonable to divide the early or late groups by 30 days.

摘要

背景与目的

使用荟萃分析技术评估肝移植再(reLT)中移植间隔对患者和移植物存活率的影响。

方法

检索截至 2022 年 1 月的文献,以确定评估患者存活率、移植物存活率和间隔时间的比较研究。使用固定或随机效应模型计算合并的风险比(HR)或风险比(RR)和 95%置信区间(95%CI)。

结果

12 篇文章被纳入本荟萃分析。30 天组中,晚期 reLT 的存活率优于早期 reLT,而在其他时间组中无统计学意义。晚期 reLT 的患者存活率在 1 年和 5 年时明显高于早期 reLT(分别为:RR,0.81[95%CI,0.73-0.89];RR,0.64[95%CI,0.46-0.88])。晚期 reLT 的移植物存活率在 1 年时明显高于早期 reLT(RR,0.75[95%CI,0.63-0.89])。早期组再移植后死亡的风险比晚期组高 1.43 倍(HR,1.43[95%CI,1.21-1.71])。

结论

晚期 reLT 的存活率明显优于早期 reLT,通过将 30 天作为早期或晚期的分界点,移植间隔的划分更为合理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/b37c9a4cd278/medi-102-e35165-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/b144306b49e1/medi-102-e35165-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/872c9b045464/medi-102-e35165-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/e4d82f13a91e/medi-102-e35165-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/b37c9a4cd278/medi-102-e35165-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/b144306b49e1/medi-102-e35165-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/872c9b045464/medi-102-e35165-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/e4d82f13a91e/medi-102-e35165-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab5e/10508473/b37c9a4cd278/medi-102-e35165-g004.jpg

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The Liver Retransplantation Risk Score: a prognostic model for survival after adult liver retransplantation.肝移植后再移植风险评分:成人肝移植后生存的预后模型。
Transpl Int. 2021 Oct;34(10):1928-1937. doi: 10.1111/tri.13956. Epub 2021 Jul 16.
3
OPTN/SRTR 2019 Annual Data Report: Liver.OPTN/SRTR 2019 年度数据报告:肝脏。
Am J Transplant. 2021 Feb;21 Suppl 2:208-315. doi: 10.1111/ajt.16494.
4
Retransplantation After Living Donor Liver Transplantation: Data from the Adult to Adult Living Donor Liver Transplantation Study.再次肝移植:来自成人活体肝移植研究的数据。
Transplantation. 2021 Jun 1;105(6):1297-1302. doi: 10.1097/TP.0000000000003361.
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The Impact of COVID-19 on Organ Donation, Procurement, and Liver Transplantation in the United States.2019年冠状病毒病对美国器官捐赠、获取及肝移植的影响
Hepatol Commun. 2020 Oct 18;5(1):5-11. doi: 10.1002/hep4.1620. eCollection 2021 Jan.
6
Pediatric retransplantation of the liver: A prognostic scoring tool.小儿肝移植后复发:预后评分工具。
Pediatr Transplant. 2020 Nov;24(7):e13775. doi: 10.1111/petr.13775. Epub 2020 Aug 13.
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COVID-19: A global transplant perspective on successfully navigating a pandemic.COVID-19:从全球移植角度成功应对大流行。
Am J Transplant. 2020 Jul;20(7):1773-1779. doi: 10.1111/ajt.15876. Epub 2020 Apr 12.
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