Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier, France.
Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France; Sorbonne Université, Paris, France.
HPB (Oxford). 2024 Aug;26(8):1033-1039. doi: 10.1016/j.hpb.2024.05.004. Epub 2024 May 15.
Appropriate risk stratification for the difficulty of liver transplantation (LT) is essential to guide the selection and acceptance of grafts and avoid morbidity and mortality.
Based on 987 LTs collected from 5 centers, perioperative outcomes were analyzed across the 3 difficulty levels. Each LT was retrospectively scored from 0 to 10. Scores of 0-2, 3-5 and 6-10 were then translated into respective difficulty levels: low, moderate and high. Complications were reported according to the comprehensive complication index (CCI).
The difficulty level of LT in 524 (53%), 323 (32%), and 140 (14%) patients was classified as low, moderate and high, respectively. The values of major intraoperative outcomes, such as cold ischemia time (p = 0.04) and operative time (p < 0.0001) increased gradually with statistically significant values among difficulty levels. There was a corresponding increase in CCI (p = 0.04), severe complication rates (p = 0.05) and length of ICU (p = 0.01) and hospital (p = 0.004) stays across the different difficulty levels.
The LT difficulty classification has been validated.
对肝移植（LT）难度进行适当的风险分层对于指导供体的选择和接受，避免发病率和死亡率至关重要。
基于来自 5 个中心的 987 例 LT，分析了 3 个难度级别下的围手术期结果。每例 LT 均从 0 到 10 进行回顾性评分。0-2 分、3-5 分和 6-10 分分别表示难度级别为低、中、高。根据综合并发症指数（CCI）报告并发症。
524 例（53%）、323 例（32%）和 140 例（14%）患者的 LT 难度级别分别归类为低、中、高。主要术中结局（如冷缺血时间（p=0.04）和手术时间（p<0.0001））随着难度级别的增加而逐渐增加，且差异具有统计学意义。CCI（p=0.04）、严重并发症发生率（p=0.05）以及 ICU（p=0.01）和住院（p=0.004）时间也相应增加。
LT 难度分类已经得到验证。
