目标:英国于2018年推出了国家肝脏提供计划(NLOS),将死者的肝脏提供给国家候补名单上的患者,对于大多数患者来说,计算出的移植收益。在NLOS之前,肝脏由地理捐赠区提供给移植中心,在中心内,估计接受者需要移植。
方法:分析了英国移植注册中心关于患者注册和移植的数据,以建立移植后生存(M1)和生存(M2)统计模型。分析了一个单独的注册队列-之前模型没有看到-以模拟M1,M2和移植收益评分(TBS)模型(结合M1和M2)下的肝脏分配。并将这些拨款与书记官处记录的拨款进行比较。使用等待名单上的死亡人数和患者生命年来比较不同的模拟方案并选择最佳分配模型。对登记处数据进行了监测,在NLOS之前和之后,了解该计划的性能。
结果:TBS被确定为最佳模型,可将脑死亡(DBD)后供体的肝脏提供给成年和大型儿科择期接受者,在NLOS成立的头两年,68%的DBD肝脏使用TBS提供给这种类型的接受者。监测数据表明,与NLOS前相比,NLOS后等待名单上的死亡率显着下降(p<0.0001),并且患者在上市后的生存率明显高于NLOS前(p=0.005)。
结论:在NLOS提供的头两年中,等待名单死亡率下降,而移植后的生存没有受到负面影响,实现方案的目标。
■2018年在英国引入了国家肝脏提供计划(NLOS),以提高已故供体肝脏提供过程的透明度。最大限度地提高候补名单人口的总体生存率,并提高获得肝移植的公平性。据我们所知,这是第一个基于移植益处的统计预测提供器官的方案;移植益处评分(TBS)。结果对移植社区很重要-从医疗保健从业者到患者-并证明,在NLOS提供的头两年,等待名单死亡率下降,而移植后的存活率没有受到负面影响,从而实现该计划的目标。继续监测该方案,以确保TBS保持最新,并调查表明某些患者可能存在缺点的信号。
OBJECTIVE: The National Liver Offering Scheme (NLOS) was introduced in the UK in 2018 to offer livers from deceased donors to patients on the national waiting list based, for most patients, on calculated transplant benefit. Before NLOS, livers were offered to transplant centres by geographic donor zones and, within centres, by estimated recipient need for a transplant.
METHODS: UK Transplant Registry data on patient registrations and transplants were analysed to build statistical models for survival on the list (M1) and survival post-transplantation (M2). A separate cohort of registrations - not seen by the models before - was analysed to simulate what liver allocation would have been under M1, M2 and a transplant benefit score (TBS) model (combining both M1 and M2), and to compare these allocations to what had been recorded in the UK Transplant Registry. The number of deaths on the waiting list and patient life years were used to compare the different simulation scenarios and to select the optimal allocation model. Registry data were monitored, pre- and post-NLOS, to understand the performance of the scheme.
RESULTS: The TBS was identified as the optimal model to offer donation after brain death (DBD) livers to adult and large paediatric elective recipients. In the first 2 years of NLOS, 68% of DBD livers were offered using the TBS to this type of recipient. Monitoring data indicate that mortality on the waiting list post-NLOS significantly decreased compared with pre-NLOS (p <0.0001), and that patient survival post-listing was significantly greater post- compared to pre-NLOS (p = 0.005).
CONCLUSIONS: In the first two years of NLOS offering, waiting list mortality fell while post-transplant survival was not negatively impacted, delivering on the scheme\'s objectives.
UNASSIGNED: The National Liver Offering Scheme (NLOS) was introduced in the UK in 2018 to increase transparency of the deceased donor liver offering process, maximise the overall survival of the waiting list population, and improve equity of access to liver transplantation. To our knowledge, it is the first scheme that offers organs based on statistical prediction of transplant benefit: the transplant benefit score. The results are important to the transplant community - from healthcare practitioners to patients - and demonstrate that, in the first two years of NLOS offering, waiting list mortality fell while post-transplant survival was not negatively impacted, thus delivering on the scheme\'s objectives. The scheme continues to be monitored to ensure that the transplant benefit score remains up-to-date and that signals that suggest the possible disadvantage of some patients are investigated.