Liver transplant allocation policies and outcomes in United States: A comprehensive review  

作　　者：Nyan L Latt Mumtaz Niazi Nikolaos T Pyrsopoulos 

机构地区：[1]Division of Gastroenterology and Hepatology,Department of Medicine,Rutgers-New Jersey Medical School,Newark,NJ 07101-1709,United States

出　　处：《World Journal of Methodology》2022年第1期32-42,共11页世界方法学杂志

摘　　要：Liver transplant allocation policies in the United States has evolved over 3 decades.The donor liver organs are matched,allocated and procured by the Organ Procurement and Transplantation Network which is administered by the United Network of Organ Sharing(UNOS),a not-for-profit organization governed by the United States human health services.We reviewed the evolution of liver transplant allocation policies.Prior to 2002,UNOS used Child-Turcotte-Pugh score to list and stratify patients for liver transplantation(LT).After 2002,UNOS changed its allocation policy based on model for end-stage liver disease(MELD)score.The serum sodium is the independent indicator of mortality risk in patients with chronic liver disease.The priority assignment of MELD-sodium score resulted in LT and prevented mortality on waitlist.MELD-Sodium score was implemented for liver allocation policy in 2016.Prior to the current and most recent policy,livers from adult donors were matched first to the status 1A/1B patients located within the boundaries of the UNOS regions and donor-service areas(DSA).We reviewed the disadvantages of the DSA-based allocation policies and the advantages of the newest acuity circle allocation model.We then reviewed the standard and non-standard indications for MELD exceptions and the decision-making process of the National Review Liver Review Board.Finally,we reviewed the liver transplant waitlist,donation and survival outcomes in the United States.

关 键 词：Liver transplant ALLOCATION Distribution Waiting list POLICIES Acuity circles Transplant exceptions National Review Liver Review Board 

分 类 号：R57[医药卫生—消化系统]