Klose, J.; Klose, M.A.; Metz, C.; Lehner, F.; Manns, M.P. et al.: Outcome stagnation of liver transplantation for primary sclerosing cholangitis in the Model for End-Stage Liver Disease era. In: Langenbeck's Archives of Surgery 399 (2014), Nr. 8, S. 1021-1029. DOI: https://doi.org/10.1007/s00423-014-1214-6
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 |
Publikationstyp: | Article |
Publikationsstatus: | publishedVersion |
Erstveröffentlichung: | 2014 |
Die Publikation erscheint in Sammlung(en): | Philosophische Fakultät |
Pos. | Land | Downloads | ||
---|---|---|---|---|
Anzahl | Proz. | |||
1 | Germany | 87 | 66,92% | |
2 | United States | 19 | 14,62% | |
3 | China | 7 | 5,38% | |
4 | Ireland | 3 | 2,31% | |
5 | Hungary | 3 | 2,31% | |
6 | Indonesia | 2 | 1,54% | |
7 | Czech Republic | 2 | 1,54% | |
8 | Canada | 2 | 1,54% | |
9 | Chile | 1 | 0,77% | |
10 | Switzerland | 1 | 0,77% | |
andere | 3 | 2,31% |
Hinweis
Zur Erhebung der Downloadstatistiken kommen entsprechend dem „COUNTER Code of Practice for e-Resources“ international anerkannte Regeln und Normen zur Anwendung. COUNTER ist eine internationale Non-Profit-Organisation, in der Bibliotheksverbände, Datenbankanbieter und Verlage gemeinsam an Standards zur Erhebung, Speicherung und Verarbeitung von Nutzungsdaten elektronischer Ressourcen arbeiten, welche so Objektivität und Vergleichbarkeit gewährleisten sollen. Es werden hierbei ausschließlich Zugriffe auf die entsprechenden Volltexte ausgewertet, keine Aufrufe der Website an sich.