移植选择模拟:为酒精相关性肝炎进行肝移植
Gene Y Im1, Aparna Goel2, Sumeet Asrani3
1Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, Recanati/Miller Transplantation Institute, New York, New York, USA.
概括
对与酒精相关的肝炎 (AH) 进行模拟肝移植 (LT) 选择表明,提供者优先考虑以患者为中心的结果,而不是严格戒酒. 在大多数情况下,多数投票与LT后复发一致,突出显示了对移植成功的定义的转变.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
- 心理社会医学 心理社会医学
背景情况:
- 对酒精相关性肝炎 (AH) 的肝移植 (LT) 面临挑战,包括候选人选择主观性,移植后酒精复发风险和健康公平问题.
- 评估心理社会风险对于确定AH患者的LT资格至关重要,但客观的预测工具和共识仍在争论中.
研究的目的:
- 在AH患者中模拟LT的候选人选择过程.
- 评估心理社会评分的预测准确性,并评估多学科团队投票与实际后LT结果的一致性.
- 为了探索提供者对"成功"的定义,在LT中为AH.
主要方法:
- 一个涉及68名医疗保健提供者的模拟讨论了4个具有不同心理社会风险概况的假设AH候选人.
- 参与者通过民主选择过程对LT的资格进行了投票.
- 达拉斯共识标准的预测准确性,斯坦福移植综合心理社会评估 (SIPAT) 和QuickTrans得分与LT后酒精复发进行了评估.
主要成果:
- 大多数供应商投票接受最低风险的候选人,并拒绝最高风险的候选人为LT.
- 对于边界风险候选人来说,较窄的多数人投票拒绝LT.
- 达拉斯,SIPAT和QuickTrans得分的预测准确率为50%,而预测LT后持续饮酒的准确率为25%.
- 大多数投票结果与4名模拟患者中的3名LT后复发一致.
- 提供者在定义AH的LT成功时,优先考虑了全移植体的健康和生活质量,而不是严格的禁欲.
结论:
- 一个民主模拟过程可以作为一个学习模型来评估在AH中选择LT候选人的学习模式.
- 现有的心理社会评分显示,对LT后酒精复发的预测准确性有限.
- 提供者对HT的LT成功的观点正在向以患者为中心的结果发展,强调生活质量和全移植存活率.
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