扩大结直肠肝转移的 MELD 例外:数据与政策。

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI:10.1097/MOT.0000000000001142
Jenna N Whitrock, Catherine G Pratt, Shimul A Shah
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引用次数: 0

摘要

审查目的:虽然肝移植治疗无法切除的结直肠癌肝转移灶(CRLM)已被证明是一种很有前景的治疗方法,但这些患者的MELD评分通常较低,而且缺乏特例点,这可能会导致在接受死亡供体肝脏移植时遇到困难:多项研究表明,接受肝移植的部分 CRLM 患者的预后有所改善,目前正在进行的几项试验将在未来几年内结束。最近,有人建议对符合条件的 CRLM 患者采用 MELD 例外点,以帮助这类患者更及时地获得高质量的同种异体肝移植。根据目前的建议,CRLM 患者将获得其所在中心的移植时 MELD 中位数(MMaT)减去 20 的分数,如果 MMaT 减去 20 后小于 15,则最低分数为 15。摘要:为需要移植的结直肠癌肝转移患者提供 MELD 例外分数可缩短这些患者的等待时间并改善其预后。
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Expanding MELD exceptions for colorectal liver metastasis: data and policy.

Purpose of review: While liver transplant for unresectable colorectal cancer liver metastases (CRLM) has been demonstrated to be a promising treatment in selected patients, the typically low MELD score of these patients and lack of exception points may lead to challenges in receiving a deceased donor liver for transplant.

Recent findings: Several studies have shown improved outcomes in select patients with CRLM who undergo liver transplant, and several trials are ongoing and will conclude in the next several years. MELD exception points have recently been proposed in qualifying patients with CRLM to help this group obtain more timely quality allografts. Under the current proposal, patients with CRLM would receive a score of the median MELD at transplant (MMaT) for their center minus 20 with a minimum score of 15 in cases where MMaT minus 20 would be less than 15. This would allow them to receive transplants faster without competing unnecessarily with those with greater medical need.

Summary: Giving MELD exception points to patients with colorectal cancer liver metastases in need of transplant may decrease time on the waitlist and improve outcomes for these patients.

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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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