青春期晚期和青年期肝移植失败风险高。

High Risk of Liver Allograft Failure During Late Adolescence and Young Adulthood.

作者信息

Foster Bethany J, Dahhou Mourad, Zhang Xun, Dharnidharka Vikas R, Conway Jennifer, Ng Vicky Lee

机构信息

1 Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Faculty of Medicine, Montreal, Quebec, Canada. 2 Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada. 3 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. 4 Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 5 St. Louis Children's Hospital, St. Louis, MO. 6 Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada. 7 Division of Gastroentrology, Hepatology and Nutrition, Department of Pediatrics, SickKids Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

出版信息

Transplantation. 2016 Mar;100(3):577-84. doi: 10.1097/TP.0000000000001009.

DOI:10.1097/TP.0000000000001009

PMID:26588009

Abstract

BACKGROUND

Graft failure risk is highest during emerging adulthood (17-24 years) in kidney and heart transplant. It is unknown whether a similar association exists in liver transplant recipients.

METHODS

We sought to estimate the relative hazards of graft failure at different current ages, compared with those aged 21 to 24 years. We evaluated 17 181 patients recorded in the Scientific Registry of Transplant Recipients who received a first isolated liver transplant at 40 years or younger (1988-2013) and had 6 months or longer of graft function. We used time-dependent Cox models to estimate the association between current age and failure risk, defined as retransplant or death after graft failure; observation was censored at death with graft function.

RESULTS

There were 2540 failures. Absolute graft failure rates were highest in ages 25 to 29 years (3.0/100 person-years). Compared with individuals with the same time since transplantation, those aged 21 to 24 years had significantly higher failure rates than those younger than 17 years and older than 34 years; hazards did not differ for those aged 25 to 29 years (1.03 [0.86, 1.24]) and were lower, but not significantly, for those aged 17 to 20 years (hazards ratio, 0.83; 95% confidence interval, 0.68-1.01) and ages 30 to 34 years (hazards ratio, 0.84; 95% confidence interval, 0.70-1.01).

CONCLUSIONS

Among young first isolated liver transplant recipients, graft failure risks are highest in the period from 21 to 29 years of age.

摘要

背景

在肾移植和心脏移植中，移植失败风险在成年早期（17 - 24岁）最高。肝移植受者中是否存在类似关联尚不清楚。

方法

我们试图估计与21至24岁的患者相比，不同当前年龄的移植失败相对风险。我们评估了移植受者科学登记处记录的17181例患者，这些患者在40岁及以下（1988 - 2013年）接受了首次孤立肝移植，且移植功能持续6个月或更长时间。我们使用时间依赖性Cox模型来估计当前年龄与失败风险之间的关联，失败风险定义为移植失败后的再次移植或死亡；观察在移植功能存在时因死亡而被截尾。

结果

共有2540例失败。绝对移植失败率在25至29岁最高（3.0/100人年）。与移植后时间相同的个体相比，21至24岁的患者失败率显著高于17岁以下和34岁以上的患者；25至29岁的患者风险无差异（1.03 [0.86, 1.24]），17至20岁（风险比，0.83；95%置信区间，0.68 - 1.01）和30至34岁（风险比，0.84；95%置信区间，0.70 - 1.01）的患者风险较低，但无显著差异。