BACKGROUND Hospital admissions are common among patients with cirrhosis,but patient factors associated with hospitalization have not been well characterized.Given recent data suggesting increased liver transplant wait...BACKGROUND Hospital admissions are common among patients with cirrhosis,but patient factors associated with hospitalization have not been well characterized.Given recent data suggesting increased liver transplant waitlist dropout among women,we hypothesized that women on the liver transplant waitlist would have increased rates of hospitalization compared with men.AIM To evaluate the role of gender on risk of hospitalization for patients on the liver transplant waitlist,in order to help explain gender disparities in waitlist outcomes.METHODS Patients listed for liver transplant at a single center in the United States were prospectively enrolled in the Functional Assessment in Liver Transplantation Study.Patients included in this retrospective analysis included those enrolled between March 2012 and December 2014 with at least 12 mo of follow up and without hepatocellular carcinoma.The primary and secondary outcomes were hospitalization and total inpatient days within 12 mo,respectively.Logistic and negative binomial regression associated baseline factors with outcomes.RESULTS Of the 392 patients,41%were female,with median(interquartile range)age 58 years(52-63)and model for end-stage liver disease 18(15-22).Within 12 mo,186(47%)patients were hospitalized≥1 time;48%were readmitted,with a median of 8(4-15)inpatient days.More women than men were hospitalized(54%vs 43%;P=0.03).In univariable analysis,female sex was associated with an increased risk of hospitalization[odds ratios(OR)1.6,95%confidence interval(CI)1.0-2.4;P=0.03],which remained significant on adjusted multivariable analysis(OR 1.6,95%CI:1.1-2.6;P=0.03).Female gender was also associated with an increased number of inpatient days within 12 mo in both univariable and multivariable regression.CONCLUSION Women with cirrhosis on the liver transplant waitlist have more hospitalizations and inpatient days in one year compared with men,suggesting that the experience of cirrhosis differs between men and women,despite similar baseline illness severity.Future studies should explore gender-specific vulnerabilities to help explain waitlist disparities.展开更多
BACKGROUND Non-alcoholic steatohepatitis(NASH)cirrhosis is the second most common indication for liver transplantation(LT).The role of body mass index(BMI)on outcomes of NASH cirrhosis has been conflicting.AIM To comp...BACKGROUND Non-alcoholic steatohepatitis(NASH)cirrhosis is the second most common indication for liver transplantation(LT).The role of body mass index(BMI)on outcomes of NASH cirrhosis has been conflicting.AIM To compare the longitudinal trajectories of patients with lean vs obese NASH cirrhosis,from listing up to post-transplant,having adjusted their BMI for ascites.METHODS We retrospectively reviewed all adult NASH patients listed for LT in our program from 2012 to 2019.Fine-Gray Competing Risk analyses and Cox Proportional-Hazard Models were performed to examine the cumulative incidence of transplant and survival outcomes respectively.RESULTS Out of 265 NASH cirrhosis listed patients,176 were included.Median age was 61.0 years;46%were females.111 patients underwent LT.Obese robust patients had better waitlist survival[hazard ratio(HR):0.12;95%CI:0.05–0.29,P<0.0001]with higher instantaneous rate of transplant(HR:5.71;95%CI:1.26–25.9,P=0.02).Lean NASH patients had a substantially higher risk of graft loss within 90 d post-LT(1.2%vs 13.8%,P=0.032)and death post-LT(2.4%vs 17.2%,P=0.029).1-3-and 5-year graft survival was poor for lean NASH(78.6%,77.3%and 41.7%vs 98.6%,96%and 85%respectively).Overall patient survival post-LT was significantly worse in lean NASH(HR:0.17;95%CI:0.03–0.86,P=0.0142)with 83%lower instantaneous rate of death in obese group.CONCLUSION Although lean NASH is considered to be more benign than obese NASH,our study suggests a paradoxical correlation of lean NASH with waitlist outcomes,and graft and patient survival post-LT.展开更多
BACKGROUND Both end-stage renal disease and being wait-listed for a kidney transplant are anxiety-causing situations.Wait-listed patients usually require arteriovenous fistula surgery for dialysis access.This procedur...BACKGROUND Both end-stage renal disease and being wait-listed for a kidney transplant are anxiety-causing situations.Wait-listed patients usually require arteriovenous fistula surgery for dialysis access.This procedure is performed under local anesthesia.We investigated the effects of music on the anxiety,perceived pain and satisfaction levels of patients who underwent fistula surgery.AIM To investigate the effect of music therapy on anxiety levels and perceived pain of patients undergoing fistula surgery.METHODS Patients who were on a waiting list for kidney transplants and scheduled for fistula surgery were randomized to control and music groups.The music group patients listened to music throughout the fistula surgery.The State-Trait Anxiety Inventory was performed to assess anxiety,additionally visual analog scale was used to evaluate perceived pain,willingness to repeat the procedure and patient satisfaction.Demographic features,comorbidities,surgical history,basic surgical data(location of fistula creation,duration of surgery,incision length)and intraoperative hemodynamic parameters were recorded by an investigator blinded to the study group.An additional trait anxiety assessment was performed following the surgery.RESULTS There was a total of 55 patients included in the study.However,14 patients did not fulfill the criteria due to requirement of sedation during surgery or uncompleted questionnaires.The remaining 41 patients were included in the analysis.There were 26 males and 15 females.The control and music groups consisted of 20 and 21 patients,respectively.With regard to basic surgical and demographic data,there was no difference between the groups.Overall patient satisfaction was significantly higher and intra-operative heart rate and blood pressure were significantly lower in the music group(P<0.05).Postoperative state anxiety levels were significantly lower in the music group.CONCLUSION Music therapy can be a complimentary treatment for patients undergoing fistula surgery.It can reduce anxiety and perceived pain,improve intraoperative hemodynamic parameters and enhance treatment satisfaction,thus may contribute to better compliance of the patients.展开更多
BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures.Surgical waiting lists(S...BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures.Surgical waiting lists(SWLs)represent a pressing problem in public healthcare.The QALY measure has rarely been used in the context of surgery.It would be interesting to know how many QALYs are lost by patients on SWLs.AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature.METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.An unlimited search was carried out in PubMed,updated on January 19,2024.Data on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions published.RESULTS Forty-eight articles were selected for the study.No data were found regarding QALYs lost on SWLs.The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles each.The country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 intestinal.Arthroplasty(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions included.Thirty-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were real-life.The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.The willingness-to-pay per QALY gained ranged from$100000 in the United States to€20000 in Spain.CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature.The rate of QALYs lost on SWLs has not been determined.Future research is warranted to address this issue.展开更多
Background:ABO-incompatible(ABOi)living-donor liver transplantation(LDLT)is increasingly considered for patients with end-stage liver disease or hepatocellular carcinoma,in regions facing severe organ shortage.However...Background:ABO-incompatible(ABOi)living-donor liver transplantation(LDLT)is increasingly considered for patients with end-stage liver disease or hepatocellular carcinoma,in regions facing severe organ shortage.However,its applicability for patients with high Model for End-stage Liver Disease(MELD)scores remains uncertain.We aimed to investigate the survival benefit of ABOi-LDLT in high MELD patients using intention-to-treat(ITT)analysis in retrospective cohort study.Methods:In a single-center study,649 patients on a liver transplantation(LT)waitlist were divided into three groups:ITT-ABOi-LDLT(n=45),ITT-ABO-compatible(ABOc)-LDLT(n=162),and ITT-deceased-donor LT(DDLT)(n=442).Results:The ITT-ABOi-LDLT group had a median initial isoagglutinin-titer of 1:128 and 71.1%underwent ABOi-LDLT after desensitization.This group showed a higher survival rate compared to ITT-DDLT(66.7%vs.28.7%,P<0.001),and ABOi-LDLT intention was linked to significantly lower mortality(hazard ratio,0.32;P<0.001).Survival among LT recipients was similar across ABOi-LDLT,DDLT,and ABOc-LDLT(P=0.13),but ABOi-LDLT recipients had higher biliary stricture rates compared to DDLT(25%vs.10%,P=0.04).Donor postoperative outcomes were comparable between ABOi-and ABOc-LDLT.Higher initial isoagglutinin-titers in ABOi-LDLT recipients were associated with increased in-hospital mortality and graft loss but not with antibody-mediated rejection or isoagglutinin-titer rebound.Conclusions:ABOi-LDLT offers a viable option for high MELD score patients,improving survival compared to DDLT and yielding similar posttransplant outcomes to DDLT and ABOc-LDLT in severe organ shortage region.展开更多
Background and Aims:Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.).We evaluat...Background and Aims:Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.).We evaluated the association between recipient MELD score at the time of surgery and survival following LDLT.Methods:All U.S.adult LDLT recipients with MELD< 25 were evaluated using the 1995-2012 United Network for Organ Sharing registry.Survival following LDLTwas stratified into three MELD categories (MELD< 15 vs.MELD 15-19 vs.MELD 20-24) and evaluated using Kaplan-Meier methods and multivariate Cox proportional hazards models.Results:Overall,2,258 patients underwent LDLT.Compared to patients with MELD< 15,overall 5-year survival following LDLT was similar among patients with MELD 15-19 (80.9% vs.80.3%,p =0.77) and MELD 20-24 (81.2% vs.80.3%,p =0.73).When compared to patients with MELD<15,there was no significant difference in long-term post-LDLT survival among those with MELD 15-19 (HR:1.11,95% CI:0.85-1.45,p =0.45) and a non-significant trend towards lower survival in patients with MELD 20-24 (HR:1.28,95%CI:0.91-1.81,p =0.16).Only 14% of LDLTs were performed in patients with MELD 20-24 and the remaining 86% in patients with MELD< 20.Conclusion:LDLT is underutilized in patients with MELD 20 and higher.展开更多
Background and Aims:Nonalcoholic steatohepatitis (NASH) is the most rapidly growing indication for liver transplantation (LT) in the United States and is on a trajectory to become the leading indication for LT in the ...Background and Aims:Nonalcoholic steatohepatitis (NASH) is the most rapidly growing indication for liver transplantation (LT) in the United States and is on a trajectory to become the leading indication for LT in the next decade.We aimed to study the trends in NASH-related LT among persons born between 1945 and 1965,the baby boomer (BB) generation.Methods:We performed a retrospective cohort analysis using population-based data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry from 2004-2015 to evaluate the birth cohort-specific trends in liver transplant waitlist registrations and liver transplant surgeries in patients with NASH.We stratified our study population into three birth cohorts:1) birth before 1945,2) birth between 1945 and 1965,and 3) birth after 1965.Results:The overall rates of NASH-related waitlist registrations and liver transplant surgeries steadily increased from 2004 to 2015 and were reflective of a sharp rise noted in the NASH BB sub-group.From 2004 to 2015,the proportion of BB patients with NASH added to LT waitlist demonstrated an incremental growth,60.6% in 2004 versus 83.2% in 2015 (p < 0.01).Among the liver transplant recipients with NASH,the proportion represented by the BB cohort increased from 56.3% in 2004 to 80.0% in 2015 (p < 0.01).Conclusion:We report rising rates of waitlist registration and LT for the indication of NASH.More importantly,the BB sub-cohort was mainly responsible for these alarming trends.展开更多
oluntary contribution has become the only source of donor lungs in China since 2015.To elaborate the outcomes of patients awaiting lung transplantation(LTx)after the implementation of donation after brain death,we per...oluntary contribution has become the only source of donor lungs in China since 2015.To elaborate the outcomes of patients awaiting lung transplantation(LTx)after the implementation of donation after brain death,we performed a retrospective study that encompassed 205 patients with end-stage lung disease who registered for LTx at Shanghai Pulmonary Hospital from January 1,2015 to January 1,2021.A total of 180 patients were enrolled in the study.The median waiting time was 1.25 months.Interstitial lung disease(ILD)(103/180,57.2%)and chronic obstructive pulmonary disease(COPD)(56/180,31.1%)were the most common diseases in our study population.The mean pulmonary artery pressure(mPAP)of patients in the died-waiting group was higher than that of the survivors(53.29+21.71 mmHg vs.42.11+18.58 mmHg,P-0.002).The mortality of patients with ILD(34/103,33.00%)was nearly twice that of patients with COPD(10/56,17.86%)while awaiting LTx(P-0.041).In the died-waiting group,patients with ILD had a shorter median waiting time than patients with COPD after being listed(0.865 months vs.4.720 months,P-0.030).ILD as primary disease and mPAP>35 mmHg were two significant independent risk factors for waitlist mortality,with hazard ratios(HR)of 3.483(95%CI 1.311-9.111;P-0.011)and 3.500(95%CI 1.435-8.536;P=0.006).Hence,LTx is more urgently needed in patients with ILD and pulmonary hypertension.展开更多
Background:The factors affecting the outcome of patients referred for lung transplantation(LTx)still have not been investigated extensively.The aim of this study was to characterize the patient outcomes and identify t...Background:The factors affecting the outcome of patients referred for lung transplantation(LTx)still have not been investigated extensively.The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx.Methods:From January 2003 to November 2013,the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery,Shanghai Pulmonary Hospital were analyzed retrospectively.The relationship between predictors and survival was evaluated using the Kaplan-Meier method and the Cox proportional hazards model.Results:Twenty-five patients(24.3%)died while awaiting the LTx.Fifty patients(48.5%)underwent LTx,and 28 patients(27.2%)were still on the waitlist.Compared to the candidates with chronic obstructive puhnonary disease(COPD),patients with idiopathic pulmonary fibrosis(IPF)had a higher mortality while awaiting the LTx(40.0%vs.12.3%,P=0.003).Patients requiring mechanical ventilation(MV)had a higher mortality while waiting than others(50.0%vs.20.2%,P=0.038).Two variables,using MV and IPF but not COPD as primary disease,emerged as significant independent risk factors for death on the waitlist(hazard ratio[HR]56.048,95%confidence interval[CI]:3.935-798.263,P=0.003 and MR=14.859,95%CI:2.69581.932,P=0.002,respectively).Conclusion:The type of end-stage lung disease,pulmonary hypertension,and MV may be distinctive prognostic factors for death while awaiting the LTx.展开更多
基金Supported by NIA Grants for Early Medical and Surgical Subspecialists’ Transition to Aging Research(R03AG045072,Lai)NIA Paul B.Beeson Career Development Award in Aging(K23AG048337,Lai)NIDDK National Research Service Award Hepatology Training Grant(T32DK060414,Rubin)
文摘BACKGROUND Hospital admissions are common among patients with cirrhosis,but patient factors associated with hospitalization have not been well characterized.Given recent data suggesting increased liver transplant waitlist dropout among women,we hypothesized that women on the liver transplant waitlist would have increased rates of hospitalization compared with men.AIM To evaluate the role of gender on risk of hospitalization for patients on the liver transplant waitlist,in order to help explain gender disparities in waitlist outcomes.METHODS Patients listed for liver transplant at a single center in the United States were prospectively enrolled in the Functional Assessment in Liver Transplantation Study.Patients included in this retrospective analysis included those enrolled between March 2012 and December 2014 with at least 12 mo of follow up and without hepatocellular carcinoma.The primary and secondary outcomes were hospitalization and total inpatient days within 12 mo,respectively.Logistic and negative binomial regression associated baseline factors with outcomes.RESULTS Of the 392 patients,41%were female,with median(interquartile range)age 58 years(52-63)and model for end-stage liver disease 18(15-22).Within 12 mo,186(47%)patients were hospitalized≥1 time;48%were readmitted,with a median of 8(4-15)inpatient days.More women than men were hospitalized(54%vs 43%;P=0.03).In univariable analysis,female sex was associated with an increased risk of hospitalization[odds ratios(OR)1.6,95%confidence interval(CI)1.0-2.4;P=0.03],which remained significant on adjusted multivariable analysis(OR 1.6,95%CI:1.1-2.6;P=0.03).Female gender was also associated with an increased number of inpatient days within 12 mo in both univariable and multivariable regression.CONCLUSION Women with cirrhosis on the liver transplant waitlist have more hospitalizations and inpatient days in one year compared with men,suggesting that the experience of cirrhosis differs between men and women,despite similar baseline illness severity.Future studies should explore gender-specific vulnerabilities to help explain waitlist disparities.
文摘BACKGROUND Non-alcoholic steatohepatitis(NASH)cirrhosis is the second most common indication for liver transplantation(LT).The role of body mass index(BMI)on outcomes of NASH cirrhosis has been conflicting.AIM To compare the longitudinal trajectories of patients with lean vs obese NASH cirrhosis,from listing up to post-transplant,having adjusted their BMI for ascites.METHODS We retrospectively reviewed all adult NASH patients listed for LT in our program from 2012 to 2019.Fine-Gray Competing Risk analyses and Cox Proportional-Hazard Models were performed to examine the cumulative incidence of transplant and survival outcomes respectively.RESULTS Out of 265 NASH cirrhosis listed patients,176 were included.Median age was 61.0 years;46%were females.111 patients underwent LT.Obese robust patients had better waitlist survival[hazard ratio(HR):0.12;95%CI:0.05–0.29,P<0.0001]with higher instantaneous rate of transplant(HR:5.71;95%CI:1.26–25.9,P=0.02).Lean NASH patients had a substantially higher risk of graft loss within 90 d post-LT(1.2%vs 13.8%,P=0.032)and death post-LT(2.4%vs 17.2%,P=0.029).1-3-and 5-year graft survival was poor for lean NASH(78.6%,77.3%and 41.7%vs 98.6%,96%and 85%respectively).Overall patient survival post-LT was significantly worse in lean NASH(HR:0.17;95%CI:0.03–0.86,P=0.0142)with 83%lower instantaneous rate of death in obese group.CONCLUSION Although lean NASH is considered to be more benign than obese NASH,our study suggests a paradoxical correlation of lean NASH with waitlist outcomes,and graft and patient survival post-LT.
文摘BACKGROUND Both end-stage renal disease and being wait-listed for a kidney transplant are anxiety-causing situations.Wait-listed patients usually require arteriovenous fistula surgery for dialysis access.This procedure is performed under local anesthesia.We investigated the effects of music on the anxiety,perceived pain and satisfaction levels of patients who underwent fistula surgery.AIM To investigate the effect of music therapy on anxiety levels and perceived pain of patients undergoing fistula surgery.METHODS Patients who were on a waiting list for kidney transplants and scheduled for fistula surgery were randomized to control and music groups.The music group patients listened to music throughout the fistula surgery.The State-Trait Anxiety Inventory was performed to assess anxiety,additionally visual analog scale was used to evaluate perceived pain,willingness to repeat the procedure and patient satisfaction.Demographic features,comorbidities,surgical history,basic surgical data(location of fistula creation,duration of surgery,incision length)and intraoperative hemodynamic parameters were recorded by an investigator blinded to the study group.An additional trait anxiety assessment was performed following the surgery.RESULTS There was a total of 55 patients included in the study.However,14 patients did not fulfill the criteria due to requirement of sedation during surgery or uncompleted questionnaires.The remaining 41 patients were included in the analysis.There were 26 males and 15 females.The control and music groups consisted of 20 and 21 patients,respectively.With regard to basic surgical and demographic data,there was no difference between the groups.Overall patient satisfaction was significantly higher and intra-operative heart rate and blood pressure were significantly lower in the music group(P<0.05).Postoperative state anxiety levels were significantly lower in the music group.CONCLUSION Music therapy can be a complimentary treatment for patients undergoing fistula surgery.It can reduce anxiety and perceived pain,improve intraoperative hemodynamic parameters and enhance treatment satisfaction,thus may contribute to better compliance of the patients.
文摘BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures.Surgical waiting lists(SWLs)represent a pressing problem in public healthcare.The QALY measure has rarely been used in the context of surgery.It would be interesting to know how many QALYs are lost by patients on SWLs.AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature.METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.An unlimited search was carried out in PubMed,updated on January 19,2024.Data on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions published.RESULTS Forty-eight articles were selected for the study.No data were found regarding QALYs lost on SWLs.The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles each.The country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 intestinal.Arthroplasty(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions included.Thirty-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were real-life.The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.The willingness-to-pay per QALY gained ranged from$100000 in the United States to€20000 in Spain.CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature.The rate of QALYs lost on SWLs has not been determined.Future research is warranted to address this issue.
文摘Background:ABO-incompatible(ABOi)living-donor liver transplantation(LDLT)is increasingly considered for patients with end-stage liver disease or hepatocellular carcinoma,in regions facing severe organ shortage.However,its applicability for patients with high Model for End-stage Liver Disease(MELD)scores remains uncertain.We aimed to investigate the survival benefit of ABOi-LDLT in high MELD patients using intention-to-treat(ITT)analysis in retrospective cohort study.Methods:In a single-center study,649 patients on a liver transplantation(LT)waitlist were divided into three groups:ITT-ABOi-LDLT(n=45),ITT-ABO-compatible(ABOc)-LDLT(n=162),and ITT-deceased-donor LT(DDLT)(n=442).Results:The ITT-ABOi-LDLT group had a median initial isoagglutinin-titer of 1:128 and 71.1%underwent ABOi-LDLT after desensitization.This group showed a higher survival rate compared to ITT-DDLT(66.7%vs.28.7%,P<0.001),and ABOi-LDLT intention was linked to significantly lower mortality(hazard ratio,0.32;P<0.001).Survival among LT recipients was similar across ABOi-LDLT,DDLT,and ABOc-LDLT(P=0.13),but ABOi-LDLT recipients had higher biliary stricture rates compared to DDLT(25%vs.10%,P=0.04).Donor postoperative outcomes were comparable between ABOi-and ABOc-LDLT.Higher initial isoagglutinin-titers in ABOi-LDLT recipients were associated with increased in-hospital mortality and graft loss but not with antibody-mediated rejection or isoagglutinin-titer rebound.Conclusions:ABOi-LDLT offers a viable option for high MELD score patients,improving survival compared to DDLT and yielding similar posttransplant outcomes to DDLT and ABOc-LDLT in severe organ shortage region.
文摘Background and Aims:Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.).We evaluated the association between recipient MELD score at the time of surgery and survival following LDLT.Methods:All U.S.adult LDLT recipients with MELD< 25 were evaluated using the 1995-2012 United Network for Organ Sharing registry.Survival following LDLTwas stratified into three MELD categories (MELD< 15 vs.MELD 15-19 vs.MELD 20-24) and evaluated using Kaplan-Meier methods and multivariate Cox proportional hazards models.Results:Overall,2,258 patients underwent LDLT.Compared to patients with MELD< 15,overall 5-year survival following LDLT was similar among patients with MELD 15-19 (80.9% vs.80.3%,p =0.77) and MELD 20-24 (81.2% vs.80.3%,p =0.73).When compared to patients with MELD<15,there was no significant difference in long-term post-LDLT survival among those with MELD 15-19 (HR:1.11,95% CI:0.85-1.45,p =0.45) and a non-significant trend towards lower survival in patients with MELD 20-24 (HR:1.28,95%CI:0.91-1.81,p =0.16).Only 14% of LDLTs were performed in patients with MELD 20-24 and the remaining 86% in patients with MELD< 20.Conclusion:LDLT is underutilized in patients with MELD 20 and higher.
文摘Background and Aims:Nonalcoholic steatohepatitis (NASH) is the most rapidly growing indication for liver transplantation (LT) in the United States and is on a trajectory to become the leading indication for LT in the next decade.We aimed to study the trends in NASH-related LT among persons born between 1945 and 1965,the baby boomer (BB) generation.Methods:We performed a retrospective cohort analysis using population-based data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry from 2004-2015 to evaluate the birth cohort-specific trends in liver transplant waitlist registrations and liver transplant surgeries in patients with NASH.We stratified our study population into three birth cohorts:1) birth before 1945,2) birth between 1945 and 1965,and 3) birth after 1965.Results:The overall rates of NASH-related waitlist registrations and liver transplant surgeries steadily increased from 2004 to 2015 and were reflective of a sharp rise noted in the NASH BB sub-group.From 2004 to 2015,the proportion of BB patients with NASH added to LT waitlist demonstrated an incremental growth,60.6% in 2004 versus 83.2% in 2015 (p < 0.01).Among the liver transplant recipients with NASH,the proportion represented by the BB cohort increased from 56.3% in 2004 to 80.0% in 2015 (p < 0.01).Conclusion:We report rising rates of waitlist registration and LT for the indication of NASH.More importantly,the BB sub-cohort was mainly responsible for these alarming trends.
基金This work was supported by the grants from the National Natural Science Foundation of China(Nos.81100061 and 81670089)the Shanghai Municipal Commission of Health and Family Planning(No.201640225)+1 种基金the Science and Technology Commission of Shanghai Municipality(No.19411964100)the Startup Fund for scientific research,Fujian Medical University(No.2019 QH1278).
文摘oluntary contribution has become the only source of donor lungs in China since 2015.To elaborate the outcomes of patients awaiting lung transplantation(LTx)after the implementation of donation after brain death,we performed a retrospective study that encompassed 205 patients with end-stage lung disease who registered for LTx at Shanghai Pulmonary Hospital from January 1,2015 to January 1,2021.A total of 180 patients were enrolled in the study.The median waiting time was 1.25 months.Interstitial lung disease(ILD)(103/180,57.2%)and chronic obstructive pulmonary disease(COPD)(56/180,31.1%)were the most common diseases in our study population.The mean pulmonary artery pressure(mPAP)of patients in the died-waiting group was higher than that of the survivors(53.29+21.71 mmHg vs.42.11+18.58 mmHg,P-0.002).The mortality of patients with ILD(34/103,33.00%)was nearly twice that of patients with COPD(10/56,17.86%)while awaiting LTx(P-0.041).In the died-waiting group,patients with ILD had a shorter median waiting time than patients with COPD after being listed(0.865 months vs.4.720 months,P-0.030).ILD as primary disease and mPAP>35 mmHg were two significant independent risk factors for waitlist mortality,with hazard ratios(HR)of 3.483(95%CI 1.311-9.111;P-0.011)and 3.500(95%CI 1.435-8.536;P=0.006).Hence,LTx is more urgently needed in patients with ILD and pulmonary hypertension.
基金the grants from the National Natural Science Foundation of China(No.81100061 and No.81170075).
文摘Background:The factors affecting the outcome of patients referred for lung transplantation(LTx)still have not been investigated extensively.The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx.Methods:From January 2003 to November 2013,the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery,Shanghai Pulmonary Hospital were analyzed retrospectively.The relationship between predictors and survival was evaluated using the Kaplan-Meier method and the Cox proportional hazards model.Results:Twenty-five patients(24.3%)died while awaiting the LTx.Fifty patients(48.5%)underwent LTx,and 28 patients(27.2%)were still on the waitlist.Compared to the candidates with chronic obstructive puhnonary disease(COPD),patients with idiopathic pulmonary fibrosis(IPF)had a higher mortality while awaiting the LTx(40.0%vs.12.3%,P=0.003).Patients requiring mechanical ventilation(MV)had a higher mortality while waiting than others(50.0%vs.20.2%,P=0.038).Two variables,using MV and IPF but not COPD as primary disease,emerged as significant independent risk factors for death on the waitlist(hazard ratio[HR]56.048,95%confidence interval[CI]:3.935-798.263,P=0.003 and MR=14.859,95%CI:2.69581.932,P=0.002,respectively).Conclusion:The type of end-stage lung disease,pulmonary hypertension,and MV may be distinctive prognostic factors for death while awaiting the LTx.
