دورية أكاديمية
أعرض في EDS

No Improvement in Intention-to-treat Survival and Increasing Liver Nonutilization Rate During the MELD Era.

التفاصيل البيبلوغرافية
العنوان: No Improvement in Intention-to-treat Survival and Increasing Liver Nonutilization Rate During the MELD Era.
المؤلفون: Matsumoto R; Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY., Verna EC; Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY., Rosenblatt R; Center for Liver Disease and Transplantation, Weill Cornell Medical Center, New York, NY., Emond JC; Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY., Brown RS Jr; Center for Liver Disease and Transplantation, Weill Cornell Medical Center, New York, NY., Rahnemai-Azar AA; Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY., Samstein B; Center for Liver Disease and Transplantation, Weill Cornell Medical Center, New York, NY., Dove LM; Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY., Kato T; Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY.
المصدر: Transplantation [Transplantation] 2024 Oct 01; Vol. 108 (10), pp. 2100-2108. Date of Electronic Publication: 2024 Apr 16.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0132144 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-6080 (Electronic) Linking ISSN: 00411337 NLM ISO Abbreviation: Transplantation Subsets: MEDLINE
أسماء مطبوعة: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore, Williams & Wilkins.
مواضيع طبية MeSH: Liver Transplantation*/mortality , Liver Transplantation*/trends , Waiting Lists*/mortality , Registries* , Intention to Treat Analysis* , End Stage Liver Disease*/surgery , End Stage Liver Disease*/mortality , End Stage Liver Disease*/diagnosis, Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Adult ; Tissue Donors/supply & distribution ; Tissue Donors/statistics & numerical data ; Treatment Outcome ; Time Factors ; Risk Factors ; Risk Assessment ; Aged ; Tissue and Organ Procurement/trends ; Patient Dropouts/statistics & numerical data ; Survival Rate/trends ; Donor Selection/trends ; Graft Survival
مستخلص: Background: Although post liver transplant survival rates have significantly improved during the past 2-3 decades, the trend in intention-to-treat (ITT) survival (survival from waitlist addition) has not been well studied.
Methods: We conducted a retrospective analysis of Scientific Registry of Transplant Recipients data to determine the trend in ITT survival in liver transplant candidates. Adult (age ≧ 18 y) patients who were on the waitlist between the time period of March 1, 2002, to December 31, 2019 (n = 200 816) and deceased liver donors that were registered between the same time period (n = 152 593) were analyzed.
Results: We found a constant increase in posttransplant survival rates; however, the ITT survival rates showed no statistically significant improvement through the study period. We observed significant linear increase in waitlist dropout rates over time. We also observed linear increase in liver nonutilization rate in both entire cases and brain-dead cases. Donor risk index increased significantly over the years; however, it was mostly driven by increase in donation after circulatory death cases; without donation after circulatory death cases, donor risk index was stable throughout the 17 y we observed.
Conclusions: The reason of the increased liver nonutilization rate is unclear; however, it is possible that reluctance to use high-risk organ to maintain better posttransplant outcomes contributed to this increase, which also could have led to increase in waitlist dropout rates and no improvements in ITT survival. Further investigation is warranted on the increased nonutilization rates to improve over all contribution of liver transplant to patient care.
Competing Interests: The authors declare no funding or conflicts of interest.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
References: Zanetto A, Shalaby S, Gambato M, et al. New indications for liver transplantation. J Clin Med. 2021;10:3867.
Ivanics T, Abreu P, Martin ED, et al. Changing trends in liver transplantation: challenges and solutions. Transplantation. 2021;105:743–756.
Kwong AJ, Kim WR, Lake JR, et al. OPTN/SRTR 2019 annual data report: liver. Am J Transplant. 2021;21:208–315.
Jay C, Schold JD. Measuring transplant center performance: the goals are not controversial but the methods and consequences can be. Curr Transplant Rep. 2017;4:52–58.
Hamilton TE. Improving organ transplantation in the United States—a regulatory perspective. Am J Transplant. 2008;8:2503–2505.
Department of Health and Human Services. Medicare program; hospital conditions of participation: requirements for approval and re-approval of transplant centers to perform organ transplants; final rule. Fed Regist. 2007;72:15198–15280.
Adler JT, Axelrod DA. Regulations’ impact on donor and recipient selection for liver transplantation: how should outcomes be measured and MELD exception scores be considered? AMA J Ethics. 2016;18:133–142.
Batra RK, Mulligan DC. Current status: meeting the regulatory goals of your liver transplant program. Curr Opin Organ Transplant. 2021;26:146–151.
Abecassis MM, Burke R, Klintmalm GB, et al.; American Society of Transplant Surgeons. American Society of Transplant Surgeons transplant center outcomes requirements—a threat to innovation. Am J Transplant. 2009;9:1279–1286.
Chandraker A, Andreoni KA, Gaston RS, et al. Time for reform in transplant program-specific reporting: AST/ASTS transplant metrics taskforce. Am J Transplant. 2019;19:1888–1895.
Orman ES, Mayorga ME, Wheeler SB, et al. Declining liver graft quality threatens the future of liver transplantation in the United States. Liver Transplant. 2015;21:1040–1050.
Kwong A, Kim WR, Lake JR, et al. OPTN/SRTR 2018 annual data report: liver. Am J Transplant. 2020;20(Suppl s1):193–299.
Giorgakis E, Mathur AK. Expedited placement to maximize utilization of marginal organs. Curr Opin Organ Transplant. 2020;25:640–646.
Israni AK, Zaun D, Rosendale JD, et al. OPTN/SRTR 2019 annual data report: deceased organ donors. Am J Transplant. 2021;21:567–604.
Rana A, Sigireddi RR, Halazun KJ, et al. Predicting liver allograft discard: the discard risk index. Transplantation. 2018;102:1520–1529.
Yi Z, Mayorga ME, Orman ES, et al. Trends in characteristics of patients listed for liver transplantation will lead to higher rates of waitlist removal due to clinical deterioration. Transplantation. 2017;101:2368–2374.
تواريخ الأحداث: Date Created: 20240416 Date Completed: 20240925 Latest Revision: 20240925
رمز التحديث: 20240925
DOI: 10.1097/TP.0000000000005018
PMID: 38622762
قاعدة البيانات: MEDLINE
الوصف
تدمد:1534-6080
DOI:10.1097/TP.0000000000005018