Malik Tahir H, Keeney Emma, Jang Anna, Hafeez Muhammad Saad, McDonald Malcolm F, Goff Cameron, Anand Adrish, Allam Anthony, Mitrani Robert, Cholankeril George, O'Mahony Christine, Cotton Ronald, Galvan Thao N, Goss John A, Rana Abbas A
Department of Medicine, New York University, New York City, NY.
Office of Student Affairs, Baylor College of Medicine, Houston, TX.
Transplantation. 2025 May 1;109(5):823-831. doi: 10.1097/TP.0000000000005235. Epub 2024 Nov 15.
Thousands of people die or are removed from the liver transplant waitlist because of deterioration. One major challenge is the donor shortage. Increasing extended criteria donor (ECD) allograft usage can address this. We assessed whether transplanting ECD allografts provides a survival benefit versus remaining on the waitlist for standard allocation.
A retrospective analysis of 132 073 liver transplant recipients from 2002 to 2020 via the United National Organ Sharing database was performed. Three survival analyses were performed on model end-stage liver disease (MELD) score inclusive ranges: 8-9, 10-15, and 16-18. Within each analysis, cohorts were divided into "transplanted" or the corresponding "intent-to-treat (ITT)" category. The transplanted cohort was separated into 2 definitions of ECD allografts: donations after circulatory death and donations from donors older than 70 y, along with all-other allografts. Ten-year survival was compared between the 3 transplanted groups and the ITT group.
When adjusted for covariates, multivariable Cox proportional hazards regression analyses demonstrated that both ECD allografts and all-other allografts had better survival as compared with the ITT cohorts in each of separate analyses for MELD range 10-15 and MELD range 16-18 ( P < 0.05).
In patients with MELD scores as low as 10, there is a survival benefit to using ECD allografts compared with those followed on an ITT basis.
数千人因病情恶化而死亡或被从肝移植等待名单中移除。一个主要挑战是供体短缺。增加边缘供体（ECD）同种异体移植物的使用可以解决这一问题。我们评估了移植ECD同种异体移植物与继续留在等待名单上接受标准分配相比是否能带来生存益处。
通过美国器官共享联合网络数据库对2002年至2020年的132073例肝移植受者进行回顾性分析。对终末期肝病模型（MELD）评分的不同范围进行了三项生存分析：8 - 9分、10 - 15分和16 - 18分。在每项分析中，队列被分为“移植组”或相应的“意向性治疗（ITT）组”。移植队列被分为ECD同种异体移植物的两种定义：循环死亡后捐赠和70岁以上供体的捐赠，以及所有其他同种异体移植物。比较了三个移植组和ITT组的十年生存率。
在对协变量进行调整后，多变量Cox比例风险回归分析表明，在MELD范围为10 - 15分和MELD范围为16 - 18分的单独分析中，ECD同种异体移植物和所有其他同种异体移植物的生存率均优于ITT队列（P < 0.05）。
对于MELD评分低至10分的患者，与按ITT方式随访的患者相比，使用ECD同种异体移植物可带来生存益处。
