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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >The Precise Relationship Between Model for End-Stage Liver Disease and Survival Without a Liver Transplant
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The Precise Relationship Between Model for End-Stage Liver Disease and Survival Without a Liver Transplant

机译：终末期肝病模型与无肝移植生存率之间的精确关系

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BACKGROUND AND AIMS: Scores from the Model for End-Stage Liver Disease (MELD), which are used to prioritize candidates for deceased donor livers, are widely acknowledged to be negatively correlated with the 90-day survival rate without a liver transplant. However, inconsistent and outdated estimates of survival probabilities by MELD preclude useful applications of the MELD score. APPROACH AND RESULTS: Using data from all prevalent liver waitlist candidates from 2016 to 2019, we estimated 3-day, 7-day, 14-day, 30-day, and 90-day without-transplant survival probabilities (with confidence intervals) for each MELD score and status IA. We used an adjusted Kaplan-Meier model to avoid unrealistic assumptions and multiple observations per person instead of just the observation at listing. We found that 90-day without-transplant survival has improved over the last decade, with survival rates increasing >10 (in absolute terms) for some MELD scores. We demonstrated that MELD correctly prioritizes candidates in terms of without-transplant survival probability but that status 1A candidates' short-term without-transplant survival is higher than that of MELD 40 candidates and lower than that of MELD 39 candidates. Our primary result is the updated survival functions themselves. CONCLUSIONS: We calculated without-transplant survival probabilities for each MELD score (and status 1A). The survival function is an invaluable tool for many applications in liver transplantation: awarding of exception points, calculating the relative demand for deceased donor livers in different geographic areas, calibrating the pediatric end-stage liver disease score, and deciding whether to accept an offered liver.
机译：背景和目标：终末期肝病模型 （MELD） 的分数用于确定已故供体肝脏候选者的优先级，被广泛认为与没有肝移植的 90 天生存率呈负相关。然而，MELD 对生存概率的不一致和过时的估计排除了 MELD 评分的有用应用。方法和结果：使用2016年至2019年所有流行的肝脏候补名单候选者的数据，我们估计了每个MELD评分和IA状态的3天、7天、14天、30天和90天无移植生存概率（带置信区间）。我们使用调整后的Kaplan-Meier模型来避免不切实际的假设和每个人的多次观察，而不仅仅是上市时的观察。我们发现，在过去十年中，90天无移植生存率有所提高，某些MELD评分的存活率增加了>10%（绝对值）。我们证明，MELD在未移植生存概率方面正确地优先考虑了候选者，但状态1A候选者的短期无移植生存率高于MELD 40候选者，低于MELD 39候选者。我们的主要结果是更新的生存函数本身。结论：我们计算了每个MELD评分（和状态1A）的无移植生存概率。生存函数是肝移植中许多应用的宝贵工具：授予例外分数，计算不同地理区域对已故供体肝脏的相对需求，校准儿科终末期肝病评分，并决定是否接受提供的肝脏。

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