PDF(Pubmed)
Abstract：
UNASSIGNED: Liver retransplantation (reLT) has historically had inferior survival relative to primary liver transplant (LT). To improve outcomes after reLT, researchers have identified factors predicting overall (OS) and/or graft survival (GS) after reLT. This systematic review and random effects meta-analysis sought to summarize this literature to elucidate the strongest independent predictors of post-reLT.
UNASSIGNED: A systematic review was conducted to identify manuscripts reporting factors affecting survival in multivariable Cox proportional hazards analyses. Papers with overlapping cohorts were excluded.
UNASSIGNED: All 25 included studies were retrospective, and 15 (60%) were single-center studies. Patients on pre-transplant ventilation (HR, 3.11; 95% CI, 1.56-6.20; p = 0.001) and with high serum creatinine (HR, 1.46; 95% CI, 1.15-1.87; p = 0.002) had the highest mortality risk after reLT. Recipient age, Model for End-Stage Liver Disease score, donor age, and cold ischemia time >12 h also conferred a significant risk of post-reLT death (all p < 0.05). Factors affecting GS included donor age and retransplant interval (the time between LT and reLT; both p < 0.05). OS is significantly higher when the retransplant interval is ≤7 days relative to 8-30 days (p = 0.04).
UNASSIGNED: The meta-analysis was complicated by papers utilizing non-standardized cut-off values to group variables, which made between-study comparisons difficult. However, it did identify 7 variables that significantly impact survival after reLT, which could stimulate future research into improving post-reLT outcomes.
UNASSIGNED: A systematic review was conducted to identify manuscripts reporting factors affecting survival in multivariable Cox proportional hazards analyses. Papers with overlapping cohorts were excluded.
UNASSIGNED: All 25 included studies were retrospective, and 15 (60%) were single-center studies. Patients on pre-transplant ventilation (HR, 3.11; 95% CI, 1.56-6.20; p = 0.001) and with high serum creatinine (HR, 1.46; 95% CI, 1.15-1.87; p = 0.002) had the highest mortality risk after reLT. Recipient age, Model for End-Stage Liver Disease score, donor age, and cold ischemia time >12 h also conferred a significant risk of post-reLT death (all p < 0.05). Factors affecting GS included donor age and retransplant interval (the time between LT and reLT; both p < 0.05). OS is significantly higher when the retransplant interval is ≤7 days relative to 8-30 days (p = 0.04).
UNASSIGNED: The meta-analysis was complicated by papers utilizing non-standardized cut-off values to group variables, which made between-study comparisons difficult. However, it did identify 7 variables that significantly impact survival after reLT, which could stimulate future research into improving post-reLT outcomes.
摘要：
■肝脏再移植（reLT）历来相对于原发性肝移植（LT）的存活率较低。为了改善reLT后的结果，研究人员已经确定了预测reLT后总体存活(OS)和/或移植物存活(GS)的因素.本系统综述和随机效应荟萃分析旨在总结该文献，以阐明reLT后最强的独立预测因子。
■在多变量Cox比例风险分析中进行了系统评价，以确定影响生存的手稿报告因素。排除具有重叠队列的论文。
■所有25项纳入研究均为回顾性研究，15例(60%)为单中心研究.移植前通气的患者(HR，3.11；95%CI，1.56-6.20；p=0.001）和高血清肌酐（HR，1.46；95%CI，1.15-1.87；p=0.002）在reLT后死亡风险最高。收件人年龄，终末期肝病评分模型,供体年龄,冷缺血时间>12小时也赋予了reLT后死亡的显着风险（所有p<0.05）。影响GS的因素包括供体年龄和再移植间隔（LT和reLT之间的时间；均p<0.05）。当再移植间隔≤7天时，OS明显高于8-30天（p=0.04）。
■由于论文使用非标准化的截止值对变量进行分组，因此荟萃分析变得复杂，这使得研究之间的比较变得困难。然而,它确实确定了7个变量，这些变量显着影响reLT后的生存率，这可能会刺激未来的研究来改善reLT后的结果。
■在多变量Cox比例风险分析中进行了系统评价，以确定影响生存的手稿报告因素。排除具有重叠队列的论文。
■所有25项纳入研究均为回顾性研究，15例(60%)为单中心研究.移植前通气的患者(HR，3.11；95%CI，1.56-6.20；p=0.001）和高血清肌酐（HR，1.46；95%CI，1.15-1.87；p=0.002）在reLT后死亡风险最高。收件人年龄，终末期肝病评分模型,供体年龄,冷缺血时间>12小时也赋予了reLT后死亡的显着风险（所有p<0.05）。影响GS的因素包括供体年龄和再移植间隔（LT和reLT之间的时间；均p<0.05）。当再移植间隔≤7天时，OS明显高于8-30天（p=0.04）。
■由于论文使用非标准化的截止值对变量进行分组，因此荟萃分析变得复杂，这使得研究之间的比较变得困难。然而,它确实确定了7个变量，这些变量显着影响reLT后的生存率，这可能会刺激未来的研究来改善reLT后的结果。
