Okumura Kenji, Lee Joon Sub, Dhand Abhay, Sogawa Hiroshi, Veillette Gregory, John Devon, Misawa Ryosuke, Bodin Roxana, Wolf David C, Diflo Thomas, Nishida Seigo
Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY 10595, United States.
World J Transplant. 2022 Aug 18;12(8):259-267. doi: 10.5500/wjt.v12.i8.259.
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.
To assess the clinical characteristics, age-related trends, and outcomes of LT among the older population in the United States.
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).
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 ( < 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% 5.9%), hepatocellular carcinoma (14.9% 6.9%), acute liver failure (2.5% 5.2%), hepatitis C cirrhosis (HCV) (19.2 % 25.6%) and acute alcoholic hepatitis (0.13% 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 ( < 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 ( < 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, < 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.
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.
肝移植（LT）受者和供者的平均年龄在增加。尽管多年来肝移植的适应证有所变化，但关于老年人群肝移植趋势和结局的数据有限。
评估美国老年人群肝移植的临床特征、年龄相关趋势和结局。
我们分析了器官共享联合网络数据库1987 - 2019年间的数据。样本分为较年轻组（18 - 64岁）和较年长组（≥65岁）。
1987 - 2019年间，美国共进行了155758例肝移植。在此期间，受者的中位年龄上升，65岁以上肝移植受者的百分比增加（P<0.05），2019年老年人群肝移植发生率最高（1920例，23%）。与较年轻组相比，导致老年患者肝移植的常见原发性肝病病因是非酒精性脂肪性肝炎（16.4%对5.9%）、肝细胞癌（14.9%对6.9%）、急性肝衰竭（2.5%对5.2%）、丙型肝炎肝硬化（HCV）（19.2%对25.6%）和急性酒精性肝炎（0.13%对0.35%）。在老年受者组中，女性和亚洲种族比例较高，而终末期肝病模型（MELD）评分和术前机械通气率较低（P<0.01）。较年长组供者的中位年龄、女性、体重指数（BMI）、供者HCV阳性状态和供者风险指数（DRI）显著更高（P<0.01）。单因素分析中，两组移植后住院时间、1年、3年和5年移植物存活率无差异。多因素Cox风险回归分析中，较年长组在移植后5年内移植物失败风险增加（风险比：1.27，P<0.001）。受者移植物失败的其他风险因素包括男性、非裔美国人种族、再次移植、糖尿病、肝移植时机械通气、较高的MELD评分、门静脉血栓形成、HCV阳性状态和较高的DRI。
虽然老年受者人群移植物失败风险较高，但仅年龄不应成为肝移植禁忌症。仔细选择供者和受者以及术后对风险因素进行优化管理对于使该人群的移植结局最大化是必要的。
