Landscape of donor cause of death and its impact on liver transplant outcomes: a ten-year analysis from the UNOS database

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-09-01 DOI:10.1016/j.hpb.2024.05.019

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引用次数: 0

Abstract

Background

Cause of death (COD) is a predictor of liver transplant (LT) outcomes independent of donor age, yet has not been recently reappraised.

Methods

Analyzing UNOS database (2013-2022), the study explored COD trends and impacts on one-year post-LT graft survival (GS) and hazard ratios (HR) for graft failure.

Results

Of 80,282 brain-death donors, 55,413(69.0%) underwent initial LT. Anoxia became the predominant COD in 2015, increasing from 29.0% in 2013 to 45.1% in 2021, with notable increases in drug intoxication. Survival differences between anoxia and cerebrovascular accidents (CVA) recently became insignificant (P=0.95). Further analysis showed improved GS from intracranial hemorrhage/stroke (previously worse; P<0.01) (P=0.70). HRs for post-1-year graft failure showed reduced significance of CVA (vs.Anoxia) and intracranial hemorrhage/stroke (vs.any other COD) recently. Donors with intracranial hemorrhage/stroke, showing improved survival and HR, were allocated to recipients with lower MELD-Na, contrasting the trend for drug intoxication CODs.

Discussion

CVA, traditionally linked with poorer outcomes, shows improved GS and HRs (vs.Anoxia). This could be due to rising drug intoxication cases and the allocation of donors with drug intoxication to recipients with higher MELD-Na, and those with CVA to recipients with lower scores. While COD remains crucial in donor selection, proper matching can mitigate differences among CODs.

查看原文本刊更多论文

捐献者死因及其对肝移植结果的影响：UNOS 数据库的十年分析。

背景：死因（COD）是预测肝移植（LT）结果的一个独立因素，但最近尚未得到重新评估：死因（COD）是肝移植（LT）结果的预测因素，与供体年龄无关，但最近尚未得到重新评估：该研究分析了 UNOS 数据库（2013-2022 年），探讨了 COD 的趋势及其对肝移植术后一年移植存活率（GS）和移植失败危险比（HR）的影响：在80,282名脑死亡供体中，55,413人（69.0%）接受了初次LT。2015年，缺氧成为最主要的COD，从2013年的29.0%增加到2021年的45.1%，药物中毒也显著增加。缺氧和脑血管意外（CVA）之间的生存率差异最近变得不显著（P=0.95）。进一步的分析表明，颅内出血/中风的存活率有所提高（以前较差；PD 讨论）：CVA向来与较差的预后有关，但它的GS和HRs（与缺氧相比）均有所改善。这可能是由于药物中毒病例增加，以及将药物中毒的供体分配给 MELD-Na 较高的受体，而将 CVA 的供体分配给分数较低的受体。虽然COD仍然是选择供体的关键，但适当的配型可以减轻COD之间的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).