Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA.
Am J Transplant. 2024 Dec;24(12):2235-2245. doi: 10.1016/j.ajt.2024.06.004. Epub 2024 Jun 10.
Medical literature highlights differences in liver transplantation (LT) waitlist experiences among ABO blood types. Type AB candidates reportedly have higher LT rates and reduced mortality. Despite liver offering guidelines, ABO disparities persist. This study examines LT access discrepancies among blood types, focusing on type AB, and seeks equitable strategies. Using the United Network for Organ Sharing database (2003-2022), 170 276 waitlist candidates were retrospectively analyzed. Dual predictive analyses (LT opportunity and survival studies) evaluated 1-year recipient pool survival, considering waitlist and post-LT survival, alongside anticipated allocation value per recipient, under 6 scenarios. Of the cohort, 97 670 patients (57.2%) underwent LT. Type AB recipients had the highest LT rate (73.7% vs 55.2% for O), shortest median waiting time (90 vs 198 days for A), and lowest waitlist mortality (12.9% vs 23.9% for O), with the lowest median model for end-stage liver disease-sodium (MELD-Na) score (20 vs 25 for A/O). The LT opportunity study revealed that reallocating type A (or A and O) donors originally for AB recipients to A recipients yielded the greatest reduction in disparities in anticipated value per recipient, from 0.19 (before modification) to 0.08. Meanwhile, the survival study showed that ABO-identical LTs reduced disparity the most (3.5% to 2.8%). Sensitivity analysis confirmed these findings were specific to the MELD-Na score < 30 population, indicating current LT allocation may favor certain blood types. Prioritizing ABO-identical LTs for MELD-Na score < 30 recipients could ensure uniform survival outcomes and mitigate disparities.
医学文献强调了 ABO 血型在肝移植（LT）候补名单经验方面的差异。据报道，AB 型候选者的 LT 率更高，死亡率更低。尽管有肝脏提供的指南，但 ABO 差异仍然存在。本研究检查了不同血型（重点是 AB 型）的 LT 准入差异，并寻求公平的策略。使用联合器官共享网络数据库（2003-2022 年），回顾性分析了 170276 名候补名单候选人。双重预测分析（LT 机会和生存研究）评估了 1 年受者群体生存率，考虑了候补名单和 LT 后生存率，以及每个受者的预期分配价值，在 6 种情况下。在队列中，97670 名患者（57.2%）接受了 LT。AB 型受者的 LT 率最高（73.7%比 O 型的 55.2%），中位等待时间最短（90 天比 A 型的 198 天），候补名单死亡率最低（12.9%比 O 型的 23.9%），中位终末期肝病模型钠（MELD-Na）评分最低（20 比 A/O 型的 25）。LT 机会研究表明，将原本用于 AB 型受者的 A（或 A 和 O）型供者重新分配给 A 型受者，可最大程度地减少每个受者预期价值的差异，从 0.19（修改前）降至 0.08。同时，生存研究表明，ABO 同型 LT 减少差异最多（从 3.5%降至 2.8%）。敏感性分析证实这些发现特定于 MELD-Na 评分<30 的人群，表明当前 LT 分配可能有利于某些血型。对于 MELD-Na 评分<30 的受者，优先进行 ABO 同型 LT 可确保生存结果的一致性，并减轻差异。
