Disparate Intent-to-Treat Outcomes for Pediatric Liver Transplantation Based on Indication.

IF 2.7 4区 医学 Q2 Medicine Canadian Journal of Gastroenterology and Hepatology Pub Date : 2023-01-01 DOI:10.1155/2023/2859384
Anna Lang, Cameron Goff, Ashley Montgomery, Jake Lynn, Spoorthi Kamepalli, John Goss, Abbas Rana
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Abstract

Background: The impact of indication for pediatric liver transplantation on waitlist and post-transplant mortality outcomes is well known, but the impact on intent-to-treat outcomes has not been investigated. Intent-to-treat survival analysis is important in this study because it is more comprehensive, combining the transplant outcomes of waitlist mortality, post-transplant mortality, and transplant rate into a single metric to elucidate any disparities in outcomes based on indication.

Methods: Cox regression was used to analyze factors impacting survival in 8,002 children listed for liver transplant in the UNOS database between 2006 and 2016. The Kaplan-Meier method and log-rank test were used to assess differences in waitlist, post-transplant, and intent-to-treat mortality among the top 5 indications of biliary atresia, acute hepatic necrosis, metabolic disorders, hepatoblastoma, and autoimmune cirrhosis.

Results: When compared to the reference group of biliary atresia, multivariate analyses showed that every indication was associated with inferior intent-to-treat outcomes except for metabolic disorders. Hepatoblastoma (hazard ratio (HR): 3.73), autoimmune cirrhosis (HR: 1.86), and AHN (HR: 1.77) were associated with significantly increased intent-to-treat mortality. Hepatoblastoma was also associated with increased post-transplant mortality (HR: 3.77) and was the only indication significantly associated with increased waitlist mortality (HR: 6.43).

Conclusion: Significant disparity exists across all indications with respect to an increased intent-to-treat mortality, along with an increased post-transplant and waitlist mortality, when compared to the biliary atresia reference group. If further studies validate these findings, a reexamination of the equitable distribution of allografts for transplant may be warranted as well as a focus on disparities in survival after transplant.

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基于适应症的儿童肝移植不同意向治疗结果。
背景:小儿肝移植指征对等待名单和移植后死亡率的影响是众所周知的,但对治疗意向的影响尚未调查。意向治疗生存分析在本研究中很重要,因为它更全面,将等待名单死亡率、移植后死亡率和移植率的移植结果结合为一个单一的指标,以阐明基于适应症的结果的任何差异。方法:采用Cox回归分析2006年至2016年UNOS数据库中8,002例肝移植患儿的影响生存因素。Kaplan-Meier法和log-rank检验用于评估前5种指征胆道闭锁、急性肝坏死、代谢性疾病、肝母细胞瘤和自身免疫性肝硬化的等待名单、移植后和意向治疗死亡率的差异。结果:与胆道闭锁参照组相比,多变量分析显示,除代谢紊乱外,所有适应症均与较差的意向治疗结果相关。肝母细胞瘤(风险比(HR): 3.73)、自身免疫性肝硬化(HR: 1.86)和AHN (HR: 1.77)与意向治疗死亡率显著增加相关。肝母细胞瘤也与移植后死亡率增加相关(HR: 3.77),并且是唯一与等待名单死亡率增加显著相关的适应症(HR: 6.43)。结论:与胆道闭锁参照组相比,在有意治疗死亡率增加、移植后和等待名单死亡率增加方面,所有适应症都存在显著差异。如果进一步的研究证实了这些发现,重新检查同种异体移植物移植的公平分配可能是必要的,并关注移植后生存的差异。
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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
期刊最新文献
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