Little Christopher J, Biggins Scott W, Perkins James D, Kling Catherine E
Department of Surgery, University of Washington, Seattle, WA.
Department of Surgery, Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, WA.
Transplant Direct. 2024 May 16;10(6):e1630. doi: 10.1097/TXD.0000000000001630. eCollection 2024 Jun.
Small stature and female sex correlate to decreased deceased donor liver transplant (DDLT) access and higher waitlist mortality. However, efforts are being made to improve access and equity of allocation under the new continuous distribution (CD) system. Liver anteroposterior diameter (APD) is a method used by many centers to determine size compatibility for DDLT but is not recorded systematically, so it cannot be used for allocation algorithms. We therefore seek to correlate body surface area (BSA) and height to APD in donors and recipients and compare waitlist outcomes by these factors to support their use in the CD system.
APD was measured from single-center DDLT recipients and donors with cross-sectional imaging. Linear, Pearson, and PhiK correlation coefficient were used to correlate BSA and height to APD. Competing risk analysis of waitlist outcomes was performed using United Network for Organ Sharing data.
For 143 pairs, donor BSA correlated better with APD than height (PhiK = 0.63 versus 0.20). For recipient all comers, neither BSA nor height were good correlates of APD, except in recipients without ascites, where BSA correlated well (PhiK = 0.63) but height did not. However, among female recipients, BSA, but not height, strongly correlated to APD regardless of ascites status (PhiK = 0.80 without, PhiK = 0.70 with). Among male recipients, BSA correlated to APD only in those without ascites (PhiK = 0.74). In multivariable models, both BSA and height were predictive of waitlist outcomes, with higher values being associated with increased access, decreased delisting for death/clinical deterioration, and decreased living donor transplant (model concordance 0.748 and 0.747, respectively).
Taken together, BSA is a good surrogate for APD and can therefore be used in allocation decision making in the upcoming CD era to offset size and gender-based disparities among certain candidate populations.
身材矮小和女性性别与 deceased 供体肝移植（DDLT）机会减少及等待名单死亡率较高相关。然而，在新的连续分配（CD）系统下，正在努力改善分配的机会和公平性。肝脏前后径（APD）是许多中心用于确定 DDLT 大小兼容性的一种方法，但未被系统记录，因此不能用于分配算法。因此，我们试图将供体和受体的体表面积（BSA）及身高与 APD 进行关联，并按这些因素比较等待名单结果，以支持它们在 CD 系统中的应用。
通过横断面成像测量单中心 DDLT 受体和供体的 APD。使用线性、Pearson 和 PhiK 相关系数将 BSA 和身高与 APD 进行关联。利用器官共享联合网络数据对等待名单结果进行竞争风险分析。
对于 143 对数据，供体 BSA 与 APD 的相关性优于身高（PhiK = 0.63 对 0.20）。对于所有受体，除了无腹水的受体中 BSA 相关性良好（PhiK = 0.63）而身高相关性不佳外，BSA 和身高与 APD 的相关性均不佳。然而，在女性受体中，无论腹水状态如何，BSA 与 APD 均强烈相关（无腹水时 PhiK = 0.80，有腹水时 PhiK = 0.70）。在男性受体中，仅在无腹水的受体中 BSA 与 APD 相关（PhiK = 0.74）。在多变量模型中，BSA 和身高均能预测等待名单结果，数值越高与获得移植机会增加、因死亡/临床恶化而被除名的情况减少以及活体供体移植减少相关（模型一致性分别为 0.748 和 0.747）。
总体而言，BSA 是 APD 的良好替代指标，因此在即将到来的 CD 时代可用于分配决策，以抵消某些候选人群中基于体型和性别的差异。
