等待肝移植的患有终末期肝病的小型成年患者可能面临尺寸匹配的肝移植物的短缺。这可能会导致等待时间更长、等待名单删除增加以及等待名单死亡率增加。本研究旨在评估欧洲移植地区体重低于平均水平的移植候选者获得移植的机会。欧洲移植地区 2010 年至 2015 年间列入肝移植名单的 16 岁以上患者有资格纳入。在 Cox 模型中研究了体重对接受肝移植机会的影响，该模型针对终末期肝病 (MELD) 评分更新的实验室模型进行了校正，拟合为时间相关变量、血型、恶性疾病列表和年龄。使用具有 3 个自由度的自然样条来测量体重和实验室 MELD 评分，以校正非线性效应。随访结束时，移植、除名和死亡候补患者的百分比分别为 49.1%、17.9% 和体重 <60kg 的患者为 24.3% (n = 1267)，而体重 ≥60kg 的患者为 60.1%、15.1% 和 18.6% (n = 10 520)。为了达到可比较的移植机会，60 公斤和 50 公斤的移植候选者估计比 80 公斤的移植候选者分别需要多 2.8 和 4.0 的实验室 MELD 分数。体重减轻与接受移植机会的减少显着相关肝移植。这导致体重 <60 公斤的患者的等待时间显着延长、除名率更高以及候补死亡率更高。版权所有 © 2023 作者。由 Wolters Kluwer Health, Inc. 出版

Small adult patients with end-stage liver disease waitlisted for liver transplantation may face a shortage of size-matched liver grafts. This may result in longer waiting times, increased waitlist removal, and waitlist mortality. This study aims to assess access to transplantation in transplant candidates with below-average bodyweight throughout the Eurotransplant region.Patients above 16 y of age listed for liver transplantation between 2010 and 2015 within the Eurotransplant region were eligible for inclusion. The effect of bodyweight on chances of receiving a liver graft was studied in a Cox model corrected for lab-Model for End-stage Liver Disease (MELD) score updates fitted as time-dependent variable, blood type, listing for malignant disease, and age. A natural spline with 3 degrees of freedom was used for bodyweight and lab-MELD score to correct for nonlinear effects.At the end of follow-up, the percentage of transplanted, delisted, and deceased waitlisted patients was 49.1%, 17.9%, and 24.3% for patients with a bodyweight <60 kg (n = 1267) versus 60.1%, 15.1%, and 18.6% for patients with a bodyweight ≥60 kg (n = 10 520). To reach comparable chances for transplantation, 60-kg and 50-kg transplant candidates are estimated to need, respectively, up to 2.8 and 4.0 more lab-MELD points than 80-kg transplant candidates.Decreasing bodyweight was significantly associated with decreased chances to receive a liver graft. This resulted in substantially longer waiting times, higher delisting rates, and higher waitlist mortality for patients with a bodyweight <60 kg.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.