Zusammenfassung: | |
Purpose: Survival after liver transplantation (LTX) has decreased in Germany since the implementation of Model for end-stage liver disease (MELD)-based liver allocation. Primary sclerosing cholangitis (PSC) is known for its otherwise excellent outcome after LTX. The influence of MELD-based liver allocation and subsequent allocation policy alterations on the outcome of LTX for PSC is analyzed.Methods: This is a retrospective observational study including 126 consecutive patients treated with LTX for PSC between January 1, 1999 and August 31, 2012. The PSC cohort was further compared to all other indications for LTX in the study period (n = 1420) with a mean follow-up of 7.9 years (SD 3.2). Multivariate risk-adjusted analyses were performed. Alterations of allocation policy have been taken into account systematically.Results: Transplant recipients suffering from PSC are significantly younger (p < 0.001), can be discharged earlier (p = 0.018), and have lower 3-month mortality than patients with other indications (p = 0.044). The observed time on the waiting list is significantly longer for patients with PSC (p < 0.001), and there is a trend toward lower match MELD points in the PSC cohort (p = 0.052). No improvement in means of short-term mortality could be shown in relation to alterations of allocation policy within the MELD era (p = 0.375). Survival rates of the pre-MELD era did not differ significantly from those of the MELD era (p = 0.097) in multivariate risk-adjusted analysis. Patients in the MELD era suffered pre-transplant significantly more frequently from dominant bile duct stenosis (p = 0.071, p = 0.059, p = 0.048, respectively; chi2).Conclusions: Progress is stagnating in LTX for PSC. Current liver allocation for PSC patients should be reconsidered.
|
|
Lizenzbestimmungen: | CC BY 3.0 Unported - https://creativecommons.org/licenses/by/3.0/ |
Publikationstyp: | Article |
Publikationsstatus: | publishedVersion |
Erstveröffentlichung: | 2014 |
Schlagwörter (englisch): | Autoimmune liver disease, Cholangiocarcinoma, MELD-based allocation, Multivariate analysis, Outcome, Survival, adolescent, adult, age distribution, Article, child, cholestasis, controlled study, female, follow up, Germany, graft recipient, health care policy, hospital admission, hospital discharge, human, liver transplantation, male, Model For End Stage Liver Disease Score, mortality, multivariate analysis, observational study, outcome assessment, primary sclerosing cholangitis, resource allocation, retrospective study, risk assessment, survival rate, treatment indication, aged, Cholangitis, Sclerosing, end stage liver disease, epidemiology, length of stay, middle aged, operation duration, postoperative complication, preschool child, statistics and numerical data, treatment outcome, Adolescent, Adult, Aged, Child, Child, Preschool, Cholangitis, Sclerosing, End Stage Liver Disease, Female, Germany, Health Policy, Humans, Length of Stay, Liver Transplantation, Male, Middle Aged, Operative Time, Postoperative Complications, Retrospective Studies, Risk Assessment, Survival Rate, Treatment Outcome, Waiting Lists |
Fachliche Zuordnung (DDC): | 610 | Medizin, Gesundheit |
Anzeige der Dokumente mit ähnlichem Titel, Autor, Urheber und Thema.