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[肝移植] 通过更多地使用分裂肝移植来扩大肝脏供体供应:确定最佳 [复制链接]

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发表于 2019-9-9 17:59 |只看该作者 |倒序浏览 |打印
Expansion of the Liver Donor Supply Through Greater Use of Split‐Liver Transplantation: Identifying Optimal Recipients
Douglas B. Mogul
Xun Luo
Jacqueline Garonzik‐Wang
Mary G. Bowring
Allan B. Massie
Kathleen B. Schwarz
Andrew M. Cameron
John F. P. Bridges
Dorry L. Segev
First published: 19 September 2018
https://doi.org/10.1002/lt.25340
Dorry L. Segev has financial relationships from Novartis and Sanofi. Kathleen B. Schwarz has financial relationships with Gilead, Bristol‐Meyers Squibb, Roche, and Up to Date.
Douglas B. Mogul is supported by grant number 5K08HS023876‐02 from the Agency for Healthcare Research and Quality. Dorry L. Segev is supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases. Allan B. Massie is supported by grant number K01DK101677 from the National Institute of Diabetes and Digestive and Kidney Diseases.
The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of, or interpretation by, the SRTR or the US government.
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Abstract

The increased use of split‐liver transplantation (SLT) represents a strategy to increase the supply of organs. Although outcomes after SLT and whole liver transplantation (WLT) are similar on average among pediatric recipients, we hypothesized that the relationship between graft type and outcomes may vary depending on patient, donor, and surgical characteristics. We evaluated graft survival among pediatric (<18 years) deceased donor, liver‐only transplant recipients from March 2002 until December 2015 using data from the Scientific Registry of Transplant Recipients. Graft survival was assessed in a Cox proportional hazards model, with and without effect modification between graft type and donor, recipient, and surgical characteristics, to identify conditions where the risk of graft loss for SLT and WLT were similar. In a traditional multivariable model, characteristics associated with graft loss included donor age >50 years, recipient weight <10 kg, acute hepatic necrosis, autoimmune diseases, tumor, public insurance, and cold ischemia time (CIT) >8 hours. In an analysis that explored whether these characteristics modified the relationship between graft type and graft loss, many characteristics associated with loss actually had similar outcomes regardless of graft type, including weight <10 kg, acute hepatic necrosis, autoimmune diseases, and tumor. In contrast, several subgroups had worse outcomes when SLT was used, including recipient weight 10‐35 kg, non–biliary atresia cholestasis, and metabolic disease. Allocation score, share type, or CIT did not modify risk of graft type and graft failure. Although one might anticipate that individuals with higher rates of graft loss would be worse candidates for SLT, data suggest that these patients actually have similar rates of graft loss. These findings can guide surgical decision making and may support policy changes that promote the increased use of SLT for specific pediatric recipients.

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发表于 2019-9-9 18:00 |只看该作者
通过更多地使用分裂肝移植来扩大肝脏供体供应:确定最佳接受者
Douglas B. Mogul
荀洛
Jacqueline Garonzik-Wang
Mary G. Bowring
艾伦B.马西
Kathleen B. Schwarz
Andrew M. Cameron
John F. P. Bridges
Dorry L. Segev
首次发表:2018年9月19日
Https://doi.org/10.1002/lt.25340
Dorry L. Segev与诺华和赛诺菲有财务关系。 Kathleen B. Schwarz与Gilead,Bristol-Meyers Squibb,Roche和Up to Date有财务关系。
Douglas B. Mogul得到了医疗保健研究和质量机构的资助号5K08HS023876-02的支持。 Dorry L. Segev得到了国家糖尿病和消化和肾脏疾病研究所的资助号K24DK101828的支持。 Allan B. Massie得到了国家糖尿病和消化和肾脏疾病研究所的资助号K01DK101677的支持。
此处报告的数据由明尼阿波利斯医学研究基金会提供,作为移植受体科学登记处(SRTR)的承包商。这些数据的解释和报告是作者的责任,绝不应被视为SRTR或美国政府的官方政策或解释。


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分裂肝移植(SLT)的使用增加代表了增加器官供应的策略。虽然SLT和全肝移植(WLT)后的结果在儿科患者中平均相似,但我们假设移植物类型与结果之间的关系儿童(<18岁)死亡供体,3月仅肝移植受者的可绘制移植物存活率2002年至2015年12月,使用移植接受者科学登记处的数据。在Cox比例风险模型中进行评估,在移植物类型和供体,受体和手术特征之间进行和不进行效果修改,以确定SLT和WLT移植物丢失风险相似的情况。在传统的多变量模型中,与移植物丢失相关的特征包括供体年龄> 50岁,受体重量<10 kg,急性肝坏死,自体免疫在分析中探讨这些特征是否改变了移植物类型与移植物丢失之间的关系,许多相关特征无论移植类型如何,实际上都有类似的结果相反,当使用SLT时,几个亚组的结果更差,包括受体体重10-35 kg,非胆道闭锁胆汁淤积和代谢性疾病。分配得分为移植型和移植失败的风险。所见可以指导外科决策,并可能支持政策变化,促进特定儿科接受者更多地使用SLT。

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才高八斗

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发表于 2019-9-9 18:00 |只看该作者
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