提示后长期临床结果的预测因素:一个ALTA组研究研究
Yael R Nobel1, Justin R Boike2, Nikhilesh R Mazumder3
1Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York, USA.
Hepatology (Baltimore, Md.)
|September 10, 2024
概括
转性肝内移植系统分流 (TIPS) 可以使一些患者在没有肝移植的情况下长期存活. 在TIPS后重新评估移植候选人是至关重要的,特别是如果MELD-Na得分有所改善.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 干预性放射学 干预性放射学
- 移植手术 移植手术
背景情况:
- 跨内肝移植系统 (TIPS) 往往是通往肝移植 (LT) 的桥梁.
- 一些患者仅使用TIPS就能实现长期无移植生存 (TFS).
- 在TIPS后,应重新评估预后和LT需求,特别是在有利的早期结果的情况下.
研究的目的:
- 评估与TIPS后长期临床结果相关的因素.
- 确定早期TFS患者需要重新评估LT的必要性.
- 评估"目的地TIPS"作为LT的替代品的潜力.
主要方法:
- 对1127名成年TIPS受益人的回顾性队列研究.
- 对2040人年随访数据的分析.
- 调整了竞争性风险回归以评估在程序和TIPS后6个月的死亡率和TFS预测指标.
主要成果:
- 在TIPS和MELD 3.0时的MELD-Na得分与TIPS后的死亡率有关.
- 在694名早期TFS患者中,1年TFS为88%,3年TFS为57%.
- 从TIPS增加到TIPS后6个月的长期预测死亡率 (SHR1.8,p <0.01).
- 长期TFS患者的并发症率较低.
结论:
- 在TIPS后,应重新评估预后和LT需求,考虑MELD-Na变化和临床状态.
- 选择的患者可以通过"目的地提示"实现长期生存,而没有LT.
- 这种方法可以提供从门高血压并发症的自由.
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