吉林大学第一医院肝胆胰内科 宋立莎 摘译
本文首次发表于[Journal of Hepatology 2012 Apr 18]
Liver transplantation for acute liver failure in Europe:
Outcomes over 20 years from the ELTR database
Background & Aims：Liver transplantation for acute liver failure (ALF) still has a high early mortality. We evaluated changes during 20 years, and identified risk factors for poor outcome. Methods：Donor, graft, and recipient variables from the European Liver Transplant Registry database (January 1988–June 2009), were analysed. Aetiologies and time periods were compared. Three and 12-month survival models were generated from separate training data sets, which were validated. A sub-analysis was performed for recipient older than 50 years.
Results：Four thousand nine hundred and three patients were evaluated. One, 5- and 10-year patient and graft survival rates were 74%, 68%, 63%, and 63%, 57%, 50%, respectively. Survival was better in 2004–2009 compared to previous quinquennia (p <0.001), despite donors >60 years increased from 1.8% to 21%.A higher incidence of suicide or non-adherence occurred in paracetamol-related ALF (p <0.001). Death or graft loss were independently associated with male recipients (adjusted OR 1.25), recipient >50 years (1.26), incompatible ABO matching (1.93), donors >60 years (1.21), and reduced size graft (1.54).For both 3- and 12-month models, incompatible ABO matching, non-viral aetiology, and reduced size graft were associated with increased mortality/graft loss, whereas male recipients and age >50 years were associated only at 12 months.Both models had reasonable discriminative ability with good calibration at 3-months. Recipients >50 years, combined with donors >60 years resulted in 57% mortality/graft loss within first year.
Conclusions：Survival after liver transplantation has improved despite increases in donor/recipient age. Recipients >50 years paired with donors >60 years had a very high mortality/graft loss within the first year.
