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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Model for end-stage liver disease (MELD) for liver allocation: a 5-year score card.
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Model for end-stage liver disease (MELD) for liver allocation: a 5-year score card.

机译：终末期肝病（MELD）肝分配模型：5年记分卡。

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摘要

Liver allocation has always been controversial, mostly because the donor supply is inadequate to provide treatment for all candidates who can potentially derive benefit from the liver transplantation (LT) procedure. In the late 1990s, most of the controversy centered around extreme differences in waiting time among LT candidates in different geographic regions and the use of waiting time and other subjective variables that did not necessarily reflect patient disease to assign priority. In response to these concerns, the Institute of Medicine report recommended, and the Department of Health and Human Services Final Rule for the Organ Procurement and Transplantation Network (OPTN) stipulated, that liver allocation should be based on objective medical criteria with a de-emphasis on waiting time. On the basis of the Institute of Medicine report1 and other studies indicating that mortality risk was a much more appropriate measure for ranking waiting LT candidates,3 policymakers selected the Model for End-Stage Liver Disease (MELD) score as the measure of disease severity because it utilized objective, reproducible, patient-based variables only, and because it was validated as an accurate predictor of short-term mortality for most adult patients with chronic liver disease. The Pediatric End-Stage Liver Disease (PELD) score was developed as a measure of mortality for children with end-stage liver disease along similar lines. The OPTN formulated the new liver allocation policy to incorporate the MELD/PELD scores as a disease severity scale and virtually eliminated waiting time as a prioritization variable in the system.
机译：肝脏分配一直存在争议，主要是因为供体供应不足以为所有可能从肝移植（LT）程序中受益的候选人提供治疗。在1990年代后期，大多数争议集中在不同地理区域的LT候选人之间的等待时间的极端差异，以及等待时间和其他主观变量的使用，这些变量不一定反映患者疾病的优先级。针对这些担忧，医学研究所的报告提出了建议，并且卫生和公共服务部制定了器官采购和移植网络（OPTN）最终规则，规定肝脏的分配应基于客观的医学标准，并应减少重视等待时间。根据医学研究所的报告1和其他研究表明，死亡风险是对待评估的LT候选者进行排名的更合适的方法，3决策者选择了终末期肝病模型（MELD）评分作为疾病严重程度的衡量标准，因为它仅利用客观的，可重复的，基于患者的变量，并且因为它已被证实可作为大多数成人慢性肝病患者短期死亡率的准确预测指标。小儿终末期肝病（PELD）评分是按照类似的方法来衡量患有终末期肝病的儿童的死亡率。 OPTN制定了新的肝脏分配策略，将MELD / PELD评分纳入疾病严重程度评分，并实际上将等待时间消除为系统中的优先级变量。

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