通过风险分层优化肝细胞癌肝移植的优先顺序。

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2023-08-01 Epub Date: 2023-06-19 DOI:10.1097/MOT.0000000000001080
Joshua Norman, Neil Mehta, Allison Kwong
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引用次数: 0

摘要

审查目的:在美国,符合标准化合格标准的肝细胞癌(HCC)候选者通过终末期肝病模型例外点在肝移植候选名单上获得类似的优先权,而不考虑退出风险或肝移植的相对预期收益。我们需要一个更细致的HCC分配方案,以更好地体现个体对肝移植的迫切性,并优化器官的效用。在这篇综述中,我们讨论了在肝脏分配中实际使用的HCC风险预测模型的开发情况:HCC是一种异质性疾病,需要对符合当前移植资格标准的患者进行更好的风险分层。摘要:需要改进肝移植候选者的HCC风险分层,以更准确地反映他们的移植迫切性,并持续关注对肝移植后预后的潜在影响。美国计划实施肝脏分配的连续分配模式,这可能为重新考虑更公平的HCC患者分配方案提供了机会。
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Optimizing liver transplant prioritization for hepatocellular carcinoma through risk stratification.

Purpose of review: In the United States, candidates with hepatocellular carcinoma (HCC) meeting standardized qualifying criteria receive similar priority on the liver transplant waiting list through Model for End-Stage Liver Disease exception points, without consideration of the dropout risk or relative expected benefit from liver transplantation. A more nuanced allocation scheme for HCC is needed to better represent the individual urgency for liver transplant and optimize organ utility. In this review, we discuss the development of HCC risk prediction models for practical use in liver allocation.

Recent findings: HCC is a heterogenous disease that requires improved risk stratification for patients who fall within current transplant eligibility criteria. Several models have been proposed, though none have been adopted in clinical practice or liver allocation to date, due to various limitations.

Summary: Improved HCC risk stratification for liver transplant candidates is needed to more accurately represent their urgency for transplant, with continued attention to the potential impact on post-liver transplant outcomes. Plans to implement a continuous distribution model for liver allocation in the United States may provide an opportunity to re-consider a more equitable allocation scheme for patients with HCC.

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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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