vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2020-3-26-35vtio-1224Research ArticleКлиническая трансплантологияClinical TransplantologyОпределение приоритетности в выборе пациентов из листа ожидания для трансплантации печениPrioritization for liver transplantationКоробкаВ. Л.KorobkaV. L.

Ростов-на-Дону

Rostov-on-Don

КострыкинМ. Ю.KostrykinM. Y.

Ростов-на-Дону

 

Rostov-on-Don

ПасечниковВ. Д.PassetchnikovV. D.

Пасечников Виктор Дмитриевич.

Адрес: 355017, Ставрополь, ул. Авиационная, 21.

Тел. (962) 447-75-13.

Victor Passetchnikov.

Address: 21, Aviatsionnaya str., Stavropol, 355017, Russian Federation.

Phone: (962) 447-75-13.

passetchnikov@mail.ruПакЕ. С.PakE. S.

Ростов-на-Дону

Rostov-on-Don

ГБУ Ростовской области «Ростовская областная клиническая больница»; ФГБОУ ВО «Ростовский государственный медицинский университет»РоссияRostov Regional Clinical Hospital; Rostov State Medical UniversityRussian FederationГБУ Ростовской области «Ростовская областная клиническая больница»РоссияRostov Regional Clinical HospitalRussian FederationГБУ Ростовской области «Ростовская областная клиническая больница»; ФГБОУ ВО «Ставропольский государственный медицинский университет»РоссияRostov Regional Clinical Hospital; Stavropol State Medical UniversityRussian Federation2020061020202232635Copyright © Коробка В.Л., Кострыкин М.Ю., Пасечников В.Д., Пак Е.С., 20202020Коробка В.Л., Кострыкин М.Ю., Пасечников В.Д., Пак Е.С.Korobka V.L., Kostrykin M.Y., Passetchnikov V.D., Pak E.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1224

Цель. Определить пороговое значение показателя MELD при оценке приоритетности выбора пациентов в качестве кандидатов на трансплантацию печени. Материалы и методы. Проведено когортное исследование 350 пациентов, находившихся в листе ожидания трансплантации печени в период с 2015-го по 2020 г. Результаты. Для определения независимых предикторов смертности пациентов в листе ожидания трансплантации печени использовалась логистическая регрессионная модель. Значимыми предикторами смертного исхода стали показатели MELD и альбумина плазмы крови при включении в лист ожидания (р = 0,001 и р = 0,004 соответственно). Предсказательная ценность выявленных предикторов была подтверждена с помощью ROC-анализа (Receiver Operating Characteristic). Площадь под ROC-кривой (Area Under Curve – AUC) для показателя MELD оказалась равной 0,883 [95% доверительный интервал (ДИ) 0,828–0,939; p < 0,001]. AUC ROC для показателя альбумина оказалась равной 0,841 [95% ДИ 0,775–0,907; p < 0,001]. Отношение шансов для развития смертного исхода при условии, если показатель MELD при включении в лист ожидания ≥25, оказалось равным 3,778, 95% ДИ (1,619–7,765). Отношение шансов для развития смертного исхода при условии, если концентрация альбумина плазмы крови при включении в лист ожидания ≤30,1 г/л, оказалось равным 2,979 (95% ДИ 1,63–5,95). При пороговом значении MELD, равном 25 баллам, имелись значимые различия между выживаемостью пациентов при сравнении когорт пациентов с показателями MELD ≥25 и MELD ≤25 (Log-rank, р < 0,0001). Заключение. Исследование подтвердило высокую предсказательную способность модели MELD при определении приоритетности пациентов в листе ожидания для выполнения трансплантации печени. Определено пороговое значение этого показателя, предикторы смертного исхода, показаны значимые различия между выживаемостью пациентов при сравнении когорт пациентов с показателями MELD ≥25 и MELD ≤25.

Objective: to determine the threshold MELD scores when prioritizing for liver transplantation. Materials and methods. We conducted a cohort study of 350 patients who were waitlisted for liver transplantation between 2015 and 2020. Results. A logistic regression model was used to identify the independent predictors of liver transplantation waitlist mortality. MELD scores and serum albumin at the time of listing were significant predictors of mortality (p = 0.001 and p = 0.004, respectively). Their predictive values were confirmed using ROC (Receiver Operating Characteristic) analysis. The area under the ROC curve (AUC) was 0.883 [95% confidence interval (CI) 0.828–0.939; p < 0.001] for MELD, and 0.841 [95% CI 0.775–0.907; p < 0.001] for serum albumin. Mortality odds ratio was 3.7778, 95% CI (1.619–7.765) provided that the listing MELD score was ≥25. Mortality odds ratio was 2.979 (95% CI 1.63–5.95) provided that the listing serum albumin concentration was ≤30.1 g/L. With a threshold MELD score of 25, there were significant differences between patient survival when comparing patient cohorts with MELD ≥25 and with MELD ≤25 (Log-rank, p < 0.0001). Conclusion. The MELD model has a high predictive ability in prioritization of waitlisted candidates for liver transplantation. The threshold MELD score and mortality predictors were determined. There were significant differences between patient survival among patient cohorts with MELD ≥25 and with MELD ≤25.

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The authors declare that there are no conflicts of interest present.