Stratified Analysis of Survival Benefit for ABO-incompatible Deceased-donor Liver Transplantation:Multicenter Propensity Score-matched Study  

作　　者：Mengfan Yang Xuyong Wei Abdul Rehman Khan Qiang Wei Rui Wang Binhua Pan Kun Wang Zhisheng Zhou Di Lu Beini Cen Shuijun Zhang Wenzhi Guo Shusen Zheng Yang Yang Xiao Xu 

机构地区：[1]Department of Organ Transplantation,Qilu Hospital of Shandong University,Jinan,Shandong,China [2]Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province,Hangzhou,Zhejiang,China [3]Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou,Zhejiang,China [4]Zhejiang University School of Medicine,Hangzhou,Zhejiang,China [5]National Center for Healthcare Quality Management in Liver Transplant,Hangzhou,Zhejiang,China [6]Department of Hepatobiliary and Pancreatic Surgery,The First Affiliated Hospital of Zhengzhou University,Henan,China [7]Department of Hepatobiliary and Pancreatic Surgery,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,Zhejiang,China [8]Department of Hepatobiliary and Pancreatic Surgery,Shulan(Hangzhou)Hospital,Hangzhou,Zhejiang,China [9]Department of Hepatobiliary and Pancreatic Surgery,The Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou,Guangdong,China

出　　处：《Journal of Clinical and Translational Hepatology》2023年第4期827-838,共12页临床与转化肝病杂志（英文版）

基　　金：This research was partially supported by National Natural Science Funds for Distinguished Young Scholar of China,(No.81625003);Key Program,National Natural Science Foundation of China,(No.81930016,No.81570589,No.81702858);Youth Program of National Natural Science Foundation of Zhejiang Province(No.LQ17H160006);National S&T Major Project(No.2017ZX10203205).

摘　　要：Background and Aims:Liver transplantation(LT)using ABO-incompatible(ABOi)grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation.However,concerns of the impending prognosis associated with this option,especially for patients with liver failure and higher model for end-stage liver disease(MELD)scores,who tend to be more fragile during the waiting period before LT.Methods:Recipients undergoing LT for acute-onchronic liver failure or acute liver failure were retrospectively enrolled at four institutions.Overall survival was compared and a Cox regression analysis was performed.Propensity score matching was performed for further comparison.Patients were stratified by MELD score and cold ischemia time(CIT)to determine the subgroups with survival benefits.Results:Two hundred ten recipients who underwent ABOi LT and 1,829 who underwent ABO compatible(ABOc)LT were enrolled.The 5-year overall survival rate was significantly inferior in the ABOi group compared with the ABOc group after matching(50.6%vs.75.7%,p<0.05).For patients with MELD scores≤30,using ABOi grafts achieved a comparable overall survival rate as using ABOc grafts(p>0.05).Comparison of the survival rates revealed no statistically significant difference for patients with MELD scores≥40(p>0.05).For patients with MELD scores of 31-39,the overall survival rate was significantly inferior in the ABOi group compared with the ABOc group(p<0.001);however,the rate was increased when the liver graft CIT was<8 h.Conclusions:For recipients with MELD scores≤30,ABOi LT had a prognosis comparable to that of ABOc LT and can be regarded as a feasible option.For recipients with MELD scores≥40,ABOi should be adopted with caution in emergency cases.For recipients with MELD scores of 31-39,the ABOi LT prognosis was worse.However,those patients benefited from receiving ABOi grafts with a CIT of<8 h.

关 键 词：Liver transplantation ABO-INCOMPATIBLE Model for end-stage liver disease score Cold ischemia time Propensity score matching 

分 类 号：R657.3[医药卫生—外科学]