Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
HPB (Oxford). 2024 Sep;26(9):1141-1147. doi: 10.1016/j.hpb.2024.05.019. Epub 2024 Jun 4.
Cause of death (COD) is a predictor of liver transplant (LT) outcomes independent of donor age, yet has not been recently reappraised.
Analyzing UNOS database (2013-2022), the study explored COD trends and impacts on one-year post-LT graft survival (GS) and hazard ratios (HR) for graft failure.
Of 80,282 brain-death donors, 55,413(69.0%) underwent initial LT. Anoxia became the predominant COD in 2015, increasing from 29.0% in 2013 to 45.1% in 2021, with notable increases in drug intoxication. Survival differences between anoxia and cerebrovascular accidents (CVA) recently became insignificant (P=0.95). Further analysis showed improved GS from intracranial hemorrhage/stroke (previously worse; P<0.01) (P=0.70). HRs for post-1-year graft failure showed reduced significance of CVA (vs.Anoxia) and intracranial hemorrhage/stroke (vs.any other COD) recently. Donors with intracranial hemorrhage/stroke, showing improved survival and HR, were allocated to recipients with lower MELD-Na, contrasting the trend for drug intoxication CODs.
CVA, traditionally linked with poorer outcomes, shows improved GS and HRs (vs.Anoxia). This could be due to rising drug intoxication cases and the allocation of donors with drug intoxication to recipients with higher MELD-Na, and those with CVA to recipients with lower scores. While COD remains crucial in donor selection, proper matching can mitigate differences among CODs.
死亡原因（COD）是肝移植（LT）结果的预测因素，独立于供体年龄，但最近并未重新评估。
分析 UNOS 数据库（2013-2022 年），研究探讨了 COD 趋势及其对 LT 后 1 年移植物存活率（GS）和移植物衰竭危险比（HR）的影响。
在 80282 例脑死亡供体中，55413 例（69.0%）接受了初始 LT。缺氧成为 2015 年的主要 COD，从 2013 年的 29.0%增加到 2021 年的 45.1%，药物中毒显著增加。缺氧和脑血管意外（CVA）之间的生存差异最近变得无统计学意义（P=0.95）。进一步分析显示，颅内出血/中风（以前更差；P<0.01）的 GS 有所改善（P=0.70）。1 年后移植物衰竭的 HR 显示，CVA（与缺氧相比）和颅内出血/中风（与任何其他 COD 相比）的意义最近有所降低。颅内出血/中风的供体，显示出改善的存活率和 HR，被分配给 MELD-Na 较低的受体，与药物中毒 COD 的趋势相反。
CVA，传统上与较差的结果相关，显示出改善的 GS 和 HR（与缺氧相比）。这可能是由于药物中毒病例的增加以及将药物中毒供体分配给 MELD-Na 较高的受体，以及将 CVA 供体分配给评分较低的受体所致。虽然 COD 仍然是供体选择的关键，但适当的匹配可以减轻不同 COD 之间的差异。
