Cesta pacienta s cirhózou od registrácie do transplantačnému programu pečene, analýza 996 pacientov z registra RH7 na Slovensku

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Autoři: P. Molčan ¹ ; T. Koller ² ; S. Adamcová Selčanová ¹ ; R. Takáč ³; I. Molčanová ³; Z. Mesárošová ¹ ; L. Skladaný ¹
Působiště autorů: HEGITO (Division of Hepatology, Gastroenterology and Liver Transplantation), Department of Internal Medicine II, Slovak Medical University, F. D. Roosevelt University Hospital with Policlinic, Banská Bystrica ¹; Department of Organ Collection and Transplant Databases, F. D. Roosevelt University Hospital with Policlinic, Banská Bystrica ³; th Department of Internal Medicine, Faculty of Medicine, Comenius University and University Hospital in Bratislava ²⁵
Vyšlo v časopise: Gastroent Hepatol 2024; 78(2): 136-146
Kategorie: Hepatologie
doi: https://doi.org/10.48095/ccgh2024136

Souhrn

Analýzou 996 pacientov z registra cirhózy RH7 sme zmapovali cestu pacientov počas 4,5-ročného obdobia smerom od registrácie do transplantácie pečene. Zistili sme, že u 283 pacientov (28,4 %) sa otvoril transplantačný protokol s mediánom 4 dni od registrácie, z nich 117 (11,7 %) bolo zapísaných na čakaciu listinu s mediánom 91 dní od začiatku protokolu, a 75 (7,5 %) bolo transplantovaných s mediánom 44 dní od zapísania na čakaciu listinu. Faktory, ktoré zvyšovali pravdepodobnosť začatia transplantačného protokolu, boli nižší vek, lepšia telesná konštitúcia a výkonnosť (BMI, svalová sila, krehkosť), autoimunitná etiológia, závažnosť choroby pečene a nižšia miera systémového zápalu (leukocyty, CRP). Faktory, ktoré zvyšovali pravdepodobnosť zapísania na čakaciu listinu, boli mužské pohlavie, lepšia telesná výkonnosť, a závažnosť choroby pečene. Faktory, ktoré zvyšovali pravdepodobnosť vyradenia z čakacej listiny, boli iná ako autoimunitná etiológia, závažnosť choroby pečene a systémový zápal. Prežitie 1 a 3 roky po transplantácii sme zaznamenali u 82,6 a 78,1 % pacientov. Práca poslúži ako dôležitá lekcia z fungovania nastavených procesov s cieľom ďalšieho zefektívnenia a skvalitnenia nášho transplantačného programu.

Klíčová slova:

cirhóza pečene – transplantácia pečene – manažment – zoznam čakateľov – prognóza

Zdroje

1. GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5 (3): 245–266. doi: 10.1016/S2468-1253 (19) 30349-8.

2. Skladany L, Koller T, Molcan P et al. Prognostic usefulness of serum myostatin in advanced chronic liver disease: its relation to gender and correlation with inflammatory status. J Physiol Pharmacol 2019; 70 (3). doi: 10.26402/jpp. 2019.3.03.

3. Skladany L, Drotarova Z, Vnencakova J et al. Applicability and prognostic value of frailty assessment tools among hospitalized patients with advanced chronic liver disease. Croat Med J 2021; 62 (1): 8–16. doi: 10.3325/cmj.2021. 62.8.

4. Skladaný Ľ, Líška D, Gurín D et al. The influence of prehabilitation in patients with liver cirrhosis before liver transplantation: a randomized clinical trial. Eur J Phys Rehabil Med 2024; 60 (1): 122–129. doi: 10.23736/S1973-9087.23.08 130-3.

5. Skladany L, Vnencakova J, Laffers L et al. Adherence to Oral Nutritional Supplements After Being Discharged from the Hospital is Low but Improves Outcome in Patients with Advanced Chronic Liver Disease. Patient Prefer Adherence 2021; 14: 2559–2572. doi: 10.2147/PPA.S283034.

6. Lai JC, Covinsky KE, Dodge JL et al. Development of a novel frailty index to predict mortality in patients with end-stage liver dis- ease. Hepatology 2017; 66 (2): 564–574. doi: 10.1002/hep.29219.

7. Mahmud N. Selection for Liver Transplantation: Indications and Evaluation. Curr Hepatol Rep 2020; 19 (3): 203–212. doi: 10.1007/s11 901-020-00527-9.

8. Tieleman M, van den Berg AP, van Hoek B et al. ‘Komt mijn nieuwe lever wel op tijd?’ [‚Will I receive a liver transplant in time?‘; chance of survival of patients on the liver transplant waiting list]. Ned Tijdschr Geneeskd 2018; 162: D2 159.

9. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol 2016; 64 (2): 433–485. doi: 10.1016/j.jhep.2015.10.006.

10. Palmer WC, Lee D, Burns J et al. Liver Transplantation for Hepatocellular Carcinoma: Impact of Wait Time at a Single Center. Ann Hepatol 2017; 16 (3): 402–411. doi: 10.5604/ 16652681.1235483.

11. Mathanda R, Hamilton BK, Rybicki L et al. Time to Transplantation (TTT) for Acute Myeloid Leukemia (AML) in First Complete Remission (CR1) Is Comparable Among Adolescent and Young Adults (AYAs) and Older Adults. Biology of Blood and Marrow Transplantation 2019; 25 (3): S126. doi: https: //doi.org/10.1016/ j.bbmt.2018.12.409.

12. O‘Grady JG. Waiting List Management for Liver Transplantation. In: Kirk et al (eds). Textbook of Organ Transplantation. doi: https: //doi.org/10.1002/9781118873434.ch38.

13. Liapakis A, Morris E, Emre S. Frailty in liver transplantation: A comprehensive review. Hepatol Forum 2021; 2 (2): 80–88. doi: 10.14744/hf.2021.2021.0023.

14. Lai JC, Sonnenday CJ, Tapper EB et al. Frailty in liver transplantation: An expert opinion statement from the American Society of Transplantation Liver and Intestinal Community of Practice. Am J Transplant 2019; 19 (7): 1896–1906. doi: 10.1111/ajt.15392.

15. McAdams-DeMarco MA, Ying H, Thomas AG et al. Frailty, Inflammatory Markers, and Waitlist Mortality Among Patients With End-stage Renal Disease in a Prospective Cohort Study. Transplantation 2018; 102 (10): 1740–1746. doi: 10.1097/TP.0000000000002213.

16. Goyes D, Barba R, Medina-Morales E et al. Waitlist mortality in patients with autoimmune liver diseases. Ann Hepatol 2022; 27 (6): 100742. doi: 10.1016/j.aohep.2022.100742.

17. Tanaka T, Sugawara Y, Kokudo N. Liver transplantation and autoimmune hepatitis. Intractable Rare Dis Res 2015; 4 (1): 33–38. doi: 10.5582/irdr.2014.01034.

18. Allen AM, Heimbach JK, Larson JJ et al. Reduced Access to Liver Transplantation in Women: Role of Height, MELD Exception Scores, and Renal Function Underestimation. Transplantation 2018; 102 (10): 1710-1716. doi: 10.1097/TP. 0000000000002196.

19. Tsoris A, Marlar CA. Use Of The Child Pugh Score In Liver Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2024. 2024 [online]. Dostupné z: https: //www.ncbi.nlm.nih.gov/books/NBK542 308/.

20. Mehta N, Dodge JL, Hirose R et al. Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation. Am J Transplant 2019; 19 (8): 2210–2218. doi: 10.1111/ajt.15353.

21. Haugen CE, McAdams-DeMarco M, Holscher CM et al. Multicenter Study of Age, Frailty, and Waitlist Mortality Among Liver Transplant Candidates. Ann Surg 2020; 271 (6): 1132–1136. doi: 10.1097/SLA.0000000000003207.

22. Serrano MT, Sabroso S, Esteban LM et al. Mortality and Causes of Death After Liver Transplantation: Analysis of Sex Differences in a Large Nationwide Cohort. Transpl Int 2022; 35: 10263. doi: 10.3389/ti.2022.10263.

ORCID authors

P. Molčan 0000-0002-5551-5242,

T. Koller 0000-0001-7418-0073,

S. Adamcová Selčanová 0000-0001-8181-1937,

Z. Mesárošová 0009-0004-3848-0406,

Ľ. Skladaný 0000-0001-5171-362.

Submitted/Doručené: 3. 4. 2024

Accepted/Prijaté: 16. 4. 2024

Pavol Molčan, MD

HEGITO (Division of Hepatology, Gastroenterology and Liver Transplantation)

Department of Internal Medicine II

Slovak Medical University