肝移植的例外点:加拿大审查
Stephen E Congly1,2, Vladimir Marquez3, Rahima A Bhanji4
1Divisions of Gastroenterology and Hepatology and Transplant Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Canadian liver journal
|July 28, 2023
概括
加拿大肝移植 (LT) 的分配缺乏国家例外点政策,导致标准和授予点的区域差异很大. 需要达成全国共识,以确保在加拿大范围内公平地获得LT.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
- 卫生政策 卫生政策
背景情况:
- 异常点对于肝移植 (LT) 的分配至关重要,它解决了超出标准评分系统的死亡风险,例如用治疗末期肝病模型 (MELD-Na).
- 目前,加拿大缺乏针对LT例外点的正式国家政策,导致省际差异不太清楚.
- 进行了全面的审查,以了解在加拿大范围内授予LT的例外点的现有标准和做法.
研究的目的:
- 调查目前在加拿大肝移植分配中授予异常点的标准和做法.
- 为了识别标志的变化,点数,积累方法,以及全国范围内为LT例外点授予的最高点数.
主要方法:
- 在加拿大五个省份 (不列颠哥伦比亚省,阿尔伯塔省,安大略省,北克省,新斯科舍省) 的七个LT中心进行了一项调查.
- 该调查收集了关于例外点的指标,其授予标准,点值,积累方法和最高授予点的数据.
主要成果:
- 在加拿大各地的LT例外点分配中存在显著的异质性,只有肝肺综合征和多囊性肝病显示出国家协议.
- 不列颠哥伦比亚省和新斯科舍省使用基于MELD-Na中位数的可变点,而阿尔伯塔省,安大略省和北克省使用指示特定值.
- 端肺高血压和复发性胆管炎是下一个最常见的认可指示;北克证明了非肝硬化疾病的最正式的标准.
结论:
- 在全国范围内,对于LT例外点的指示和授予积分存在重大差异.
- 制定关于LT例外点的全国共识对于促进加拿大肝移植分配的公平性至关重要.
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