A comparison of liver transplantation outcomes in the pre- vs. post-MELD eras

被引:59
作者
Kanwal, F
Dulai, GS
Spiegel, BMR
Yee, HF
Gralnek, IM
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, VA Greater Los Angeles Healthcare Syst, Los Angeles, CA 90073 USA
[2] VA Greater Los Angeles Hlth Care Syst, Div Gastroenterol Hepatol, Los Angeles, CA USA
[3] VA Greater Los Angeles Hlth Care Syst, Div Gen Internal Med Hlth Serv Res, Los Angeles, CA USA
[4] CURE Digest Dis Res, Los Angeles, CA USA
[5] Ctr Study Digest Healthcare Qual & Outcomes, Los Angeles, CA USA
[6] Univ Calif Los Angeles, Ctr Hlth Sci, Los Angeles, CA 90024 USA
[7] Univ Calif Los Angeles, Ctr Neurovisceral Sci & Womens Hlth, Los Angeles, CA USA
关键词
D O I
10.1111/j.1365-2036.2005.02321.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: The model for end stage liver disease (MELD)-based organ allocation system is designed to prioritize orthotopic liver transplantation (OLT) for patients with the most severe liver disease. However, there are no published data to confirm whether this goal has been achieved or whether the policy has affected long-term post-OLT survival. Aim: To compare pre-OLT liver disease severity and long-term (1 year) post-OLT survival between the pre- and post-MELD eras. Methods: Using the United Network of Organ Sharing database, we compared two cohorts of adult patients undergoing cadaveric liver transplant in the pre-MELD (n = 3857) and post-MELD (n = 4245) eras. We created multivariable models to determine differences in: (i) pre-OLT liver disease severity as measured by MELD; and (ii) 1-year post-OLT outcomes. Results: Patients undergoing OLT in the post-MELD era had more severe liver disease at the time of transplantation (mean MELD = 20.5) vs. those in the pre-MELD era (mean MELD = 17.0). There were no differences in the unadjusted patient or graft survival at 1 year post-OLT. This difference remained insignificant after adjusting for a range of prespecified recipient, donor, and transplant centre-related factors in multivariable survival analysis. Conclusions: Although liver disease severity is higher in the post- vs. pre-MELD era, there has been no change in long-term post-OLT patient or graft survival. These results indicate that the MELD era has achieved its primary goals by allocating cadaveric livers to the sickest patients without compromising post-OLT survival.
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收藏
页码:169 / 177
页数:9
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