The Impact of the MELD Score at the Time of Listing for Liver Transplantation

上市时 MELD 评分对肝移植的影响

• 批准号: 7804939
• 负责人: ALYSON N FOX
• 金额: $ 3.97万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7804939
• 关键词: Accounting; Address; Adopted; Affect; Ascites; Autoimmune Process; Cessation of life; Characteristics; Chronic; Cirrhosis; Clinical; Communities; Complication; Diagnosis; Disease; Disease model; Encephalopathies; Etiology; Evaluation; Event; Excision; Financial cost; Foxes; Gastroenterologist; Hemorrhage; Hospitalization; Human; Hyponatremia; Individual; Intervention; Knowledge; Life; Liver Cirrhosis; Liver diseases; Mediating; Medical; Metabolic syndrome; Modeling; Morbidity - disease rate; Organ; Organ Transplantation; Outcome; Patient Selection; Patients; Pennsylvania; Peritonitis; Portal Hypertension; Prevalence; Process; Public Health; Refractory; Research; Research Personnel; Resources; Risk; Severities; Severity of illness; Shapes; Staging; Symptoms; System; Testing; Time; Transplant Recipients; Transplantation; Universities; Waiting Lists; Withdrawal; base; body system; cohort; cost; design; experience; improved; indexing; liver transplantation; mortality; outcome forecast; psychologic; public health relevance; therapy development

DESCRIPTION (provided by applicant): The prevalence of chronic liver disease, cinliosis and decompensated portal hypertension is on the rise and represents and important public health problem. Liver transplantation provides a life sustaining alterative to death from end stage liver disease in those who are suitable. Although transplantation is feasible, its use is limited by organ availability. Of the people listed for liver transplantation, a considerable percentage are withdrawn from the liver transplant waiting list due to death or other morbidity. Given the high personal and financial cost of inappropriate listing, it is crucial to identify the factors that prognosticate a successful listing so that we can best allocate this limited resource. The proposed research will specifically address this issue using a retrospective cohort design. In a cohort of patients listed for cadaveric liver transplantation at the University of Pennsylvania we plan to describe the relationship between the Model for End Stage Liver Disease (MELD) score at listing and the outcomes of successful transplantation, list withdrawal or death. This will be accomplished through the following three inter related specific aims: Specific Aim 1: To describe the distribution of listing MELD scores amongst patients who were successfully listed for liver transplantation (transplanted) and those who were unsuccessfully listed (withdrawn or died) in a cohort of patients listed at The University of Pennsylvania between March 2002 and March 2006. Specific Aim 2: To determine if the MELD score at the time of listing for liver transplantation is associated with the outcome of successful transplant, patient death, or withdrawal from the transplant list. Specific Aim 3: To determine if the following clinical factors are associated with the outcome of successful transplant, patient death, or withdrawal from the transplant list: etiology of liver disease or having had a complication of portal hypertension prior to listing (hyponatremia, refractory ascites, spontaneous bacterial peritonitis, variceal hemorrhage, or encephalopathy of sufficient severity to require hospitalization). PUBLIC HEALTH RELEVANCE: The proposed research will provide the transplant community with crucial information. Knowledge of the characteristics of those who are unsuccessfully listed for liver transplantation would allow the possibility of an appropriate intervention such as the allocation of "exception points". Therefore, the identification of factors associated with waiting list withdrawal or death based on the listing MELD scores is of paramount importance to improve the excess of waitlist withdrawals and deaths.

描述（由申请人提供）：慢性肝病，CINLIOSIS和代表性的遗传性高血压的患病率正在上升，代表着重要的公共卫生问题。肝移植为适合患者的终阶段肝病的死亡提供了一种维持死亡的生命。尽管移植是可行的，但其使用受到器官可用性的限制。在列出的肝移植的人中，由于死亡或其他发病率，肝移植等待名单从肝移植等待名单中撤回了相当多的比例。鉴于不当清单的个人和经济成本很高，至关重要的是要确定预测成功清单的因素，以便我们可以最好地分配有限的资源。 拟议的研究将使用回顾性队列设计专门解决此问题。在宾夕法尼亚大学列出的尸体肝移植的患者中，我们计划描述清单中末期肝病模型（MELD）分数与成功移植，清单戒断或死亡的结果之间的关系。这将通过以下三个相关特定目的来完成：具体目的1：描述在成功列出的肝脏移植（移植）的患者中列表分数的分布，以及那些在2002年3月在2002年3月之间在宾夕法尼亚大学列出的患者中列出的患者中列出的（撤回或死亡）的患者（撤回或死亡）的列表。肝移植与成功移植，患者死亡或从移植清单中提取的结果有关。 具体目的3：确定以下临床因素是否与从移植列表中成功移植，患者死亡或退出的结果是相关的：肝病的病因学或在上市之前患有门静脉高血压并发症（低钠血症，难治性腹水，难治性腹水，自发性细菌性腹膜炎，毒素性疾病症状症状症状症状症状症状症状症状）。 公共卫生相关性：拟议的研究将为移植社区提供关键信息。了解那些未成功列出肝移植的人的特征将允许进行适当的干预措施，例如分配“异常点”。因此，根据上市分数识别与等待名单提取或死亡相关的因素，对于改善候补名单撤离和死亡的过量而言至关重要。