Malinis Maricar F, Chen Shu, Allore Heather G, Quagliarello Vincent J
Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, USA.
Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, USA.
Ann Transplant. 2014 Sep 26;19:478-87. doi: 10.12659/AOT.890934.
Since 2002, the Model of End Stage Liver Disease (MELD) score has been the basis of the liver transplant (LT) allocation system. Among older adult LT recipients, short-term outcomes in the MELD era were comparable to the pre-MELD era, but long-term outcomes remain unclear.
This is a retrospective cohort study using the UNOS data on patients age ≥ 50 years who underwent primary LT from February 27, 2002 until October 31, 2011.
A total of 35,686 recipients met inclusion criteria. The cohort was divided into 5-year interval age groups. Five-year over-all survival rates for ages 50-54, 55-59, 60-64, 65-69, and 70+ were 72.2%, 71.6%, 69.5%, 65.0%, and 57.5%, respectively. Five-year graft survival rates after adjusting for death as competing risk for ages 50-54, 55-59,60-64, 65-69 and 70+ were 85.8%, 87.3%, 89.6%, 89.1% and 88.9%, respectively. By Cox proportional hazard modeling, age ≥ 60, increasing MELD, donor age ≥ 60, hepatitis C, hepatocellular carcinoma (HCC), dialysis and impaired pre-transplant functional status (FS) were associated with increased 5-year mortality. Using Fine and Gray sub-proportional hazard modeling adjusted for death as competing risk, 5-year graft failure was associated with donor age ≥ 60, increasing MELD, hepatitis C, HCC, and impaired pre-transplant FS.
Among older LT recipients in the MELD era, long-term graft survival after adjusting for death as competing risk was improved with increasing age, while over-all survival was worse. Donor age, hepatitis C, and pre-transplant FS represent potentially modifiable risk factors that could influence long-term graft and patient survival.
自2002年以来，终末期肝病模型（MELD）评分一直是肝移植（LT）分配系统的基础。在老年LT受者中，MELD时代的短期结局与MELD时代之前相当，但长期结局仍不明确。
这是一项回顾性队列研究，使用了器官共享联合网络（UNOS）关于2002年2月27日至2011年10月31日期间接受初次LT的年龄≥50岁患者的数据。
共有35686名受者符合纳入标准。该队列被分为5年间隔的年龄组。50 - 54岁、55 - 59岁、60 - 64岁、65 - 69岁和70岁及以上年龄组的5年总生存率分别为72.2%、71.6%、69.5%、65.0%和57.5%。将死亡作为竞争风险进行调整后，50 - 54岁、55 - 59岁、60 - 64岁、65 - 69岁和70岁及以上年龄组的5年移植物生存率分别为85.8%、87.3%、89.6%、89.1%和88.9%。通过Cox比例风险模型，年龄≥60岁、MELD升高、供体年龄≥60岁、丙型肝炎、肝细胞癌（HCC）、透析以及移植前功能状态（FS）受损与5年死亡率增加相关。使用将死亡作为竞争风险进行调整的Fine和Gray亚比例风险模型，5年移植物失败与供体年龄≥60岁、MELD升高、丙型肝炎、HCC以及移植前FS受损相关。
在MELD时代的老年LT受者中，将死亡作为竞争风险进行调整后，随着年龄增长，长期移植物生存率提高，而总生存率更差。供体年龄、丙型肝炎和移植前FS是可能影响长期移植物和患者生存的潜在可改变风险因素。
