Sneiders Dimitri, van Dijk Anne-Baue R M, Darwish-Murad Sarwa, van Rosmalen Marieke, Erler Nicole S, IJzermans Jan N M, Polak Wojciech G, Hartog Hermien
Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
Transplantation. 2024 May 1;108(5):1149-1156. doi: 10.1097/TP.0000000000004804. Epub 2023 Nov 13.
Small adult patients with end-stage liver disease waitlisted for liver transplantation may face a shortage of size-matched liver grafts. This may result in longer waiting times, increased waitlist removal, and waitlist mortality. This study aims to assess access to transplantation in transplant candidates with below-average bodyweight throughout the Eurotransplant region.
Patients above 16 y of age listed for liver transplantation between 2010 and 2015 within the Eurotransplant region were eligible for inclusion. The effect of bodyweight on chances of receiving a liver graft was studied in a Cox model corrected for lab-Model for End-stage Liver Disease (MELD) score updates fitted as time-dependent variable, blood type, listing for malignant disease, and age. A natural spline with 3 degrees of freedom was used for bodyweight and lab-MELD score to correct for nonlinear effects.
At the end of follow-up, the percentage of transplanted, delisted, and deceased waitlisted patients was 49.1%, 17.9%, and 24.3% for patients with a bodyweight <60 kg (n = 1267) versus 60.1%, 15.1%, and 18.6% for patients with a bodyweight ≥60 kg (n = 10 520). To reach comparable chances for transplantation, 60-kg and 50-kg transplant candidates are estimated to need, respectively, up to 2.8 and 4.0 more lab-MELD points than 80-kg transplant candidates.
Decreasing bodyweight was significantly associated with decreased chances to receive a liver graft. This resulted in substantially longer waiting times, higher delisting rates, and higher waitlist mortality for patients with a bodyweight <60 kg.
列入肝移植等候名单的成年终末期肝病小体型患者可能面临大小匹配的肝移植供体短缺的问题。这可能导致等待时间延长、等候名单上除名率增加以及等候名单死亡率上升。本研究旨在评估整个欧洲移植区域内体重低于平均水平的移植候选者获得移植的情况。
2010年至2015年期间在欧洲移植区域内列入肝移植等候名单的16岁以上患者符合纳入标准。在一个Cox模型中研究体重对获得肝移植机会的影响，该模型针对作为时间依赖性变量的实验室终末期肝病模型（MELD）评分更新、血型、恶性疾病列入名单情况和年龄进行了校正。使用具有3个自由度的自然样条对体重和实验室MELD评分进行校正，以消除非线性效应。
随访结束时，体重<60 kg的患者（n = 1267）中移植、从等候名单上除名和死亡的等候名单患者的百分比分别为49.1%、17.9%和24.3%，而体重≥60 kg的患者（n = 10520）中这一比例分别为60.1%、15.1%和18.6%。为了获得相当的移植机会，估计60 kg和50 kg的移植候选者分别比80 kg的移植候选者需要多2.8和4.0个以上的实验室MELD评分点。
体重下降与获得肝移植的机会减少显著相关。这导致体重<60 kg的患者等待时间大幅延长、除名率更高以及等候名单死亡率更高。
