被重新列入肝移植患者的病历
Fakhar Ali Qazi Arisar1, Rhea Varghese2, Shiyi Chen3
1University Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, Canada.
Annals of hepatology
|October 20, 2023
概括
重新考虑肝移植 (LT) 等候名单管理:重新列入名单的患者,通常患有移植性肝硬化,面临更糟糕的存活率和更低的移植率. 早期重新列出和标准化的例外点对于改善结果至关重要.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植医学 移植医学
- 临床结果研究研究
背景情况:
- 肝移植 (LT) 后的复发性肝硬化需要在10-30%的病例中重新移植.
- 了解重新注册患者和初级注册患者的等待列表动态对于资源配置和患者管理至关重要.
研究的目的:
- 为了比较重新列为LT的患者和主要列出的患者的结局.
- 用竞争性风险框架评估等待名单上的轨迹.
主要方法:
- 在2012年至2020年期间,对1912名列为LT的患者进行了回顾性分析.
- 采用了对整体存活率 (OS) 的Cox比例危险模型和对移植发生率的Fine-Gray竞争风险模型.
- 多变量分析确定了与移植发生率和OS相关的因素.
主要成果:
- 再测试的患者 (n=104) 较年轻,但肝/功能较差.
- 在没有异常点 (移植性肝硬化) 的情况下重新加入患者的生存状况明显恶化 (HR: 4.17) 和移植率降低 (HR: 0.56).
- 多变量分析证实了清单类型,以及临床参数 (bilirubin,INR等). ) 影响了移植发生率和OS.
结论:
- 重新测试的患者是LT等候名单人口中的少数.
- 尽管进行了仔细的选择,但重新列入名单的患者的等候名单存活率较低,移植可能性降低.
- 结果表明需要及时重新列出和标准化的例外点分配,以优化这些脆弱患者的结果.
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