Seth Rashmi, Andreoni Kenneth A
Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Sciences Center, Methodist University Hospital Transplant Institute, Memphis, TN, United States.
Department of Surgery, Division of Abdominal Transplantation, Thomas Jefferson University, Philadelphia, PA, United States.
Front Transplant. 2024 Aug 8;3:1449407. doi: 10.3389/frtra.2024.1449407. eCollection 2024.
Since the first liver transplant was performed over six decades ago, the landscape of liver transplantation in the US has seen dramatic evolution. Numerous advancements in perioperative and operative techniques have resulted in major improvements in graft and patient survival rates. Despite the increase in transplants performed over the years, the waitlist mortality rate continues to remain high. The obesity epidemic and the resultant metabolic sequelae continue to result in more marginal donors and challenging recipients. In this review, we aim to highlight the changing characteristics of liver transplant recipients and liver allograft donors. We focus on issues relevant in successfully transplanting a high model for end stage liver disease recipient. We provide insights into the current use of terms and definitions utilized to discuss marginal allografts, discuss the need to look into more consistent ways to describe these organs and propose two new concepts we coin as "Liver Allograft Variables" (LAV) and "Liver Allograft Composite Score" (LACS) for this. We discuss the development of spectrum of risk indexes as a dynamic tool to characterize an allograft in real time. We believe that this concept has the potential to optimize the way we allocate, utilize and transplant livers across the US.
自六十多年前首例肝移植手术实施以来，美国肝移植领域发生了巨大变革。围手术期和手术技术的诸多进步使得移植物和患者生存率得到显著提高。尽管多年来移植手术数量有所增加，但等待名单上的死亡率仍然居高不下。肥胖流行及其导致的代谢后遗症继续造成更多边缘供体和具有挑战性的受体。在本综述中，我们旨在突出肝移植受者和肝移植供体不断变化的特征。我们关注与成功移植终末期肝病高模型受者相关的问题。我们深入探讨当前用于讨论边缘移植物的术语和定义的使用情况，讨论寻求更一致的方式来描述这些器官的必要性，并为此提出两个新的概念，即“肝移植变量”（LAV）和“肝移植综合评分”（LACS）。我们讨论风险指数谱作为实时表征移植物的动态工具的发展。我们相信这一概念有可能优化我们在美国分配、利用和移植肝脏的方式。
