Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Palo Alto, CA.
University of Massachusetts Medical Center, Worcester, MA.
Liver Transpl. 2020 Nov;26(11):1492-1503. doi: 10.1002/lt.25863. Epub 2020 Oct 13.
The liver transplantation (LT) population is aging, with the need for transplant being driven by the growing prevalence of nonalcoholic steatohepatitis (NASH). Older LT recipients with NASH may be at an increased risk for adverse outcomes after LT. Our objective is to characterize outcomes in these recipients in a large multicenter cohort. All primary LT recipients ≥65 years from 2010 to 2016 at 13 centers in the Re-Evaluating Age Limits in Transplantation (REALT) consortium were included. Of 1023 LT recipients, 226 (22.1%) were over 70 years old, and 207 (20.2%) had NASH. Compared with other LT recipients, NASH recipients were older (68.0 versus 67.3 years), more likely to be female (47.3% versus 32.8%), White (78.3% versus 68.0%), Hispanic (12.1% versus 9.2%), and had higher Model for End-Stage Liver Disease-sodium (21 versus 18) at LT (P < 0.05 for all). Specific cardiac risk factors including diabetes with or without chronic complications (69.6%), hypertension (66.3%), hyperlipidemia (46.3%), coronary artery disease (36.7%), and moderate-to-severe renal disease (44.4%) were highly prevalent among NASH LT recipients. Graft survival among NASH patients was 90.3% at 1 year and 82.4% at 3 years compared with 88.9% at 1 year and 80.4% at 3 years for non-NASH patients (log-rank P = 0.58 and P = 0.59, respectively). Within 1 year after LT, the incidence of graft rejection (17.4%), biliary strictures (20.9%), and solid organ cancers (4.9%) were comparable. Rates of cardiovascular (CV) complications, renal failure, and infection were also similar in both groups. We observed similar posttransplant morbidity and mortality outcomes for NASH and non-NASH LT recipients. Certain CV risk factors were more prevalent in this population, although posttransplant outcomes within 1 year including CV events and renal failure were similar to non-NASH LT recipients.
肝移植（LT）人群正在老龄化，非酒精性脂肪性肝炎（NASH）的患病率不断上升，导致对移植的需求增加。接受 LT 的年龄较大的 NASH 患者在 LT 后可能面临更多的不良结局风险。我们的目标是在大型多中心队列中描述这些患者的结局。
2010 年至 2016 年，在 REALT 联盟的 13 个中心中，所有年龄≥65 岁的原发性 LT 受者均被纳入研究。在 1023 名 LT 受者中，226 名（22.1%）年龄超过 70 岁，207 名（20.2%）患有 NASH。与其他 LT 受者相比，NASH 受者年龄更大（68.0 岁比 67.3 岁），女性（47.3%比 32.8%）、白人（78.3%比 68.0%）、西班牙裔（12.1%比 9.2%）比例更高，LT 时终末期肝病模型钠（MELD-Na）评分更高（21 分比 18 分）（所有 P 值均<0.05）。NASH LT 受者中存在多种心脏特定危险因素，包括糖尿病伴或不伴慢性并发症（69.6%）、高血压（66.3%）、高脂血症（46.3%）、冠心病（36.7%）和中重度肾脏疾病（44.4%）。
NASH 患者的移植后 1 年和 3 年的移植物存活率分别为 90.3%和 82.4%，而非 NASH 患者分别为 88.9%和 80.4%（对数秩检验 P=0.58 和 P=0.59）。LT 后 1 年内，移植物排斥（17.4%）、胆狭窄（20.9%）和实体器官癌（4.9%）的发生率相似。两组的心血管（CV）并发症、肾衰竭和感染发生率也相似。
我们观察到 NASH 和非 NASH LT 受者的移植后发病率和死亡率结果相似。尽管 NASH LT 受者在移植后 1 年内包括 CV 事件和肾衰竭在内的 CV 结局与非 NASH LT 受者相似，但该人群中某些 CV 危险因素更为普遍。
