Background and Aims:Liver transplantation(LT)using ABO-incompatible(ABOi)grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation.However,concerns of the impending pro...Background and Aims:Liver transplantation(LT)using ABO-incompatible(ABOi)grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation.However,concerns of the impending prognosis associated with this option,especially for patients with liver failure and higher model for end-stage liver disease(MELD)scores,who tend to be more fragile during the waiting period before LT.Methods:Recipients undergoing LT for acute-onchronic liver failure or acute liver failure were retrospectively enrolled at four institutions.Overall survival was compared and a Cox regression analysis was performed.Propensity score matching was performed for further comparison.Patients were stratified by MELD score and cold ischemia time(CIT)to determine the subgroups with survival benefits.Results:Two hundred ten recipients who underwent ABOi LT and 1,829 who underwent ABO compatible(ABOc)LT were enrolled.The 5-year overall survival rate was significantly inferior in the ABOi group compared with the ABOc group after matching(50.6%vs.75.7%,p<0.05).For patients with MELD scores≤30,using ABOi grafts achieved a comparable overall survival rate as using ABOc grafts(p>0.05).Comparison of the survival rates revealed no statistically significant difference for patients with MELD scores≥40(p>0.05).For patients with MELD scores of 31-39,the overall survival rate was significantly inferior in the ABOi group compared with the ABOc group(p<0.001);however,the rate was increased when the liver graft CIT was<8 h.Conclusions:For recipients with MELD scores≤30,ABOi LT had a prognosis comparable to that of ABOc LT and can be regarded as a feasible option.For recipients with MELD scores≥40,ABOi should be adopted with caution in emergency cases.For recipients with MELD scores of 31-39,the ABOi LT prognosis was worse.However,those patients benefited from receiving ABOi grafts with a CIT of<8 h.展开更多
This study constructs a quasi-natural experiment based on the expansion of the Yangtze River Delta urban agglomeration(YRDUA) of China in 2010 to investigate the impact and inner mechanism of urban agglomeration expan...This study constructs a quasi-natural experiment based on the expansion of the Yangtze River Delta urban agglomeration(YRDUA) of China in 2010 to investigate the impact and inner mechanism of urban agglomeration expansion on fine particulate matter(PM_(2.5)) concentrations through propensity scores in difference-in-differences models(PSM-DID) using panel data from 286 prefecturelevel cities in China from 2003 to 2016. The results show that 1) urban agglomeration expansion contributes to an overall decrease in PM_(2.5)concentration, which is mainly achieved from the original cities. For the new cities, on the other hand, the expansion significantly increases the local PM_(2.5)concentration. 2) In the long term, the significant influence of urban agglomeration expansion on PM_(2.5)concentration lasts for three years and gradually decreases. A series of robustness tests confirm the applicability of the PSM-DID model.3) Cities with weaker government regulation, a better educated population and higher per capita income present stronger PM_(2.5)reduction effects. 4) Urban agglomeration expansion affects the PM_(2.5)concentration mainly through industrial transfer and population migration, which cause a decrease in the PM_(2.5)concentration in the original cities and an increase in the PM_(2.5)concentration in the new cities.Corresponding policy suggestions are proposed based on the conclusions.展开更多
基金This research was partially supported by National Natural Science Funds for Distinguished Young Scholar of China,(No.81625003)Key Program,National Natural Science Foundation of China,(No.81930016,No.81570589,No.81702858)+1 种基金Youth Program of National Natural Science Foundation of Zhejiang Province(No.LQ17H160006)National S&T Major Project(No.2017ZX10203205).
文摘Background and Aims:Liver transplantation(LT)using ABO-incompatible(ABOi)grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation.However,concerns of the impending prognosis associated with this option,especially for patients with liver failure and higher model for end-stage liver disease(MELD)scores,who tend to be more fragile during the waiting period before LT.Methods:Recipients undergoing LT for acute-onchronic liver failure or acute liver failure were retrospectively enrolled at four institutions.Overall survival was compared and a Cox regression analysis was performed.Propensity score matching was performed for further comparison.Patients were stratified by MELD score and cold ischemia time(CIT)to determine the subgroups with survival benefits.Results:Two hundred ten recipients who underwent ABOi LT and 1,829 who underwent ABO compatible(ABOc)LT were enrolled.The 5-year overall survival rate was significantly inferior in the ABOi group compared with the ABOc group after matching(50.6%vs.75.7%,p<0.05).For patients with MELD scores≤30,using ABOi grafts achieved a comparable overall survival rate as using ABOc grafts(p>0.05).Comparison of the survival rates revealed no statistically significant difference for patients with MELD scores≥40(p>0.05).For patients with MELD scores of 31-39,the overall survival rate was significantly inferior in the ABOi group compared with the ABOc group(p<0.001);however,the rate was increased when the liver graft CIT was<8 h.Conclusions:For recipients with MELD scores≤30,ABOi LT had a prognosis comparable to that of ABOc LT and can be regarded as a feasible option.For recipients with MELD scores≥40,ABOi should be adopted with caution in emergency cases.For recipients with MELD scores of 31-39,the ABOi LT prognosis was worse.However,those patients benefited from receiving ABOi grafts with a CIT of<8 h.
基金Under the auspices of Chinese National Funding of Social Sciences (No.17AGL005)Institute of Socialism with Chinese Characteristics of Southeast University (No.DDZTZK2021C11)。
文摘This study constructs a quasi-natural experiment based on the expansion of the Yangtze River Delta urban agglomeration(YRDUA) of China in 2010 to investigate the impact and inner mechanism of urban agglomeration expansion on fine particulate matter(PM_(2.5)) concentrations through propensity scores in difference-in-differences models(PSM-DID) using panel data from 286 prefecturelevel cities in China from 2003 to 2016. The results show that 1) urban agglomeration expansion contributes to an overall decrease in PM_(2.5)concentration, which is mainly achieved from the original cities. For the new cities, on the other hand, the expansion significantly increases the local PM_(2.5)concentration. 2) In the long term, the significant influence of urban agglomeration expansion on PM_(2.5)concentration lasts for three years and gradually decreases. A series of robustness tests confirm the applicability of the PSM-DID model.3) Cities with weaker government regulation, a better educated population and higher per capita income present stronger PM_(2.5)reduction effects. 4) Urban agglomeration expansion affects the PM_(2.5)concentration mainly through industrial transfer and population migration, which cause a decrease in the PM_(2.5)concentration in the original cities and an increase in the PM_(2.5)concentration in the new cities.Corresponding policy suggestions are proposed based on the conclusions.
