Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Liver Transpl. 2009 Nov;15(11):1481-7. doi: 10.1002/lt.21865.
Older age is considered a poor prognostic factor in acute liver failure (ALF) and may still be considered a relative contraindication for liver transplantation for ALF. We aimed to evaluate the impact of older age, defined as age > or = 60 years, on outcomes in patients with ALF. One thousand one hundred twenty-six consecutive prospective patients from the US Acute Liver Failure Study Group registry were studied. The median age was 38 years (range, 15-81 years). One thousand sixteen patients (90.2%) were younger than 60 years (group 1), and 499 (49.1%) of these had acetaminophen-induced ALF; this rate of acetaminophen-induced ALF was significantly higher than that in patients > or = 60 years (group 2; n = 110; 23.6% with acetaminophen-induced ALF, P < 0.001). The overall survival rate was 72.7% in group 1 and 60.0% in group 2 (not significant) for acetaminophen patients and 67.9% in group 1 and 48.2% in group 2 for non-acetaminophen patients (P < 0.001). The spontaneous survival rate (ie, survival without liver transplantation) was 64.9% in group 1 and 60.0% in group 2 (not significant) for acetaminophen patients and 30.8% in group 1 and 24.7% in group 2 for non-acetaminophen patients (P = 0.27). Age was not a significant predictor of spontaneous survival in multiple logistic regression analyses. Group 2 patients were listed for liver transplantation significantly less than group 1 patients. Age was listed as a contraindication for transplantation in 5 patients. In conclusion, in contrast to previous studies, we have demonstrated a relatively good spontaneous survival rate for older patients with ALF when it is corrected for etiology. However, overall survival was better for younger non-acetaminophen patients. Fewer older patients were listed for transplantation.
年龄较大被认为是急性肝衰竭（ALF）的不良预后因素，在 ALF 患者中，年龄较大可能仍被视为肝移植的相对禁忌症。我们旨在评估年龄较大（定义为年龄> = 60 岁）对 ALF 患者结局的影响。我们研究了来自美国急性肝衰竭研究组登记处的 1126 例连续前瞻性患者。中位年龄为 38 岁（范围 15-81 岁）。1016 例患者（90.2％）年龄小于 60 岁（第 1 组），其中 499 例（49.1％）患有对乙酰氨基酚诱导的 ALF；与年龄大于等于 60 岁的患者（第 2 组；n = 110；23.6％为对乙酰氨基酚诱导的 ALF）相比，这一乙酰氨基酚诱导的 ALF 发生率明显更高（P <0.001）。第 1 组的总生存率为 72.7％，第 2 组为 60.0％（无显著差异），乙酰氨基酚患者；第 1 组的自发生存率（即无肝移植生存）为 64.9％，第 2 组为 60.0％（无显著差异），乙酰氨基酚患者；第 1 组的非乙酰氨基酚患者为 30.8％，第 2 组为 24.7％（P = 0.27）。多变量逻辑回归分析显示，年龄不是自发生存的显著预测因子。第 2 组患者接受肝移植的比例明显低于第 1 组患者。第 2 组有 5 例患者因年龄列为移植禁忌症。总之，与以前的研究相比，当我们根据病因纠正时，我们发现年龄较大的 ALF 患者的自发生存率相对较好。然而，年轻的非乙酰氨基酚患者的总体生存率更好。接受移植的老年患者较少。
