| 4 | Trends and outcomes of liver transplantation among older recipients in the United States显示文摘BACKGROUND The average age of recipients and donors of liver transplantation(LT)is increasing.Although there has been a change in the indications for LT over the years,data regarding the trends and outcomes of LT in the older population is limited.AIM To assess the clinical characteristics,age-related trends,and outcomes of LT among the older population in the United States.METHODS We analyzed data from the United Network for Organ Sharing database between 1987-2019.The sample was split into younger group(18-64 years old)and older group(≥65 years old).RESULTS Between 1987-2019,155758 LT were performed in the United States.During this period there was a rise in median age of the recipients and percentage of LT recipients who were older than 65 years increased(P<0.05)with the highest incidence of LT among older population seen in 2019(1920,23%).Common primary etiologies of liver disease leading to LT in older patients when compared to the younger group,were non-alcoholic steatohepatitis(16.4%vs 5.9%),hepatocellular carcinoma(14.9%vs 6.9%),acute liver failure(2.5%vs 5.2%),hepatitis C cirrhosis(HCV)(19.2%vs 25.6%)and acute alcoholic hepatitis(0.13%vs 0.35%).In older recipient group female sex and Asian race were higher,while model for end-stage liver disease(MELD)score and rates of preoperative mechanical ventilation were lower(P<0.01).Median age of donor,female sex,body mass index(BMI),donor HCV positive status,and donor risk index(DRI)were significantly higher in older group(P<0.01).In univariable analysis,there was no difference in post-transplant length of hospitalization,one-year,three-year and five-year graft survivals between the two groups.In multivariable Cox-Hazard regression analysis,older group had an increased risk of graft failure during the five-year post-transplant period(hazard ratio:1.27,P<0.001).Other risk factors for graft failure among recipients were male sex,African American race,re-transplantation,presence of diabetes,mechanical ventilation at the time of LT,higher MELD score,presence of portal vein thrombosis,HCV positive status,and higher DRI.CONCLUSION While there is a higher risk of graft failure in older recipient population,age alone should not be a contraindication for LT.Careful selection of donors and recipients along with optimal management of risk factors during the postoperative period are necessary to maximize the transplant outcomes in this population. | Kenji Okumura Joon Sub Lee Abhay Dhand Hiroshi Sogawa Gregory Veillette Devon John Ryosuke Misawa Roxana Bodin David C Wolf Thomas Diflo Seigo Nishida | 2022 | World Journal of Transplantation2022，12，8： | 0 |
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