肝移植可以为各种虚弱程度提供生存益处：来自肝移植研究中的多中心功能评估。
Liver transplantation provides survival benefit at all levels of frailty: From the Multicenter Functional Assessment in Liver Transplantation Study.
发表日期：2024 Jul 24
作者：
Melinda Wang, Sy Han Chiou, Daniel Ganger, Jessica Ruck, Chiung-Yu Huang, Matthew R Kappus, Elizabeth A King, Daniela P Ladner, Robert S Rahimi, Andres Duarte-Rojo, Michael L Volk, Amit D Tevar, Elizabeth C Verna, Jennifer C Lai
来源：
HEPATOLOGY
摘要：
向体弱患者提供 LT 可能会降低候补死亡率，但可能会增加 LT 后死亡率。 LT生存效益是平衡这些风险的概念。我们试图通过肝衰弱指数 (LFI) 来量化 LT 的净生存获益。我们分析了 2012-2021 年多中心 LT 功能评估 (FrAILT) 研究的数据。 LT 前队列包括等待 LT 的肝硬化门诊患者，无肝细胞癌； LT 后队列包括接受 LT 的患者。主要结局是 LT 前和 LT 后死亡率。我们根据调整后的 Cox 模型计算了 1 年、3 年和 5 年限制平均生存时间 (RMST)。生存获益计算为 LT 生命年的净收益。 LT 前队列包括 2628 名患者：MELDNa 中位数为 18 (IQR 14-22)； 731 人（28%）身体虚弱； 440 人 (17%) 在 LT 前死亡。 LT 后队列包括 1335 名患者：中位 MELDNa 为 20 (IQR 14-24)； 325 人（24%）身体虚弱； 103 人 (8%) 在 LT 后死亡。随着 LFI 增加，LT 前 RMST 大幅下降。 LT 后 RMST 也随着 LFI 的增加而下降，但幅度不大。 LT 前和 LT 后 RMST 相交的 LFI 阈值不存在，患者在所有 LFI 值下均具有净生存获益。LT 前和 LT 后死亡率随着 LFI 的增加而增加（在较小程度上）。由于 LT 前死亡率的降低，移植在所有 LFI 值下都提供了生存获益。没有确定 LFI 阈值，在该阈值下 LT 后死亡率的风险超过 LT 前的死亡率。即使在选择接受 LT 的患者中存在晚期虚弱的情况下，LT 也能提供净生存获益。版权所有 © 2024 美国肝病研究协会。
Offering LT to frail patients may reduce waitlist mortality but may increase post-LT mortality. LT survival benefit is the concept of balancing these risks. We sought to quantify net survival benefit with LT by liver frailty index (LFI).We analyzed data in the multi-center Functional Assessment in LT (FrAILT) Study from 2012-2021. Pre-LT cohort included ambulatory patients with cirrhosis awaiting LT, without hepatocellular carcinoma; post-LT cohort included those who underwent LT. Primary outcomes were pre-LT and post-LT mortality. We computed 1-, 3-, and 5-year restricted mean survival times (RMST) from adjusted Cox models. Survival benefit was calculated as net gain in life-years with LT. Pre-LT cohort included 2628 patients: median MELDNa was 18 (IQR 14-22); 731 (28%) were frail; 440 (17%) died pre-LT. Post-LT cohort included 1335 patients: median MELDNa was 20 (IQR 14-24); 325 (24%) were frail; 103 (8%) died post-LT. Pre-LT RMST decreased substantially as LFI increased. Post-LT RMST also decreased as LFI increased but only modestly. There was no LFI threshold at which pre-LT and post-LT RMST intersected-patients had net survival benefit at all LFI values.Pre-LT and, to a lesser degree, post-LT mortality increased as LFI increased. Transplant offered a survival benefit at all LFI values, driven by a reduction in pre-LT mortality. No threshold of LFI was identified at which the risk of post-LT mortality exceeded pre-LT mortality. LT offers net survival benefit even in the presence of advanced frailty among those selected for LT.Copyright © 2024 American Association for the Study of Liver Diseases.