Inferior outcomes in young adults undergoing liver transplantation - a UK and Ireland cohort study.
Inferior outcomes in young adults undergoing liver transplantation - a UK and Ireland cohort study.
复制标题
接受肝移植的年轻人的预后较差——一项英国和爱尔兰队列研究。
DOI：
10.1111/tri.14033
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Briggs G
中科院分区：
文献类型：
--
作者：
Briggs G
据报道，移植物损失发生率与受体年龄呈负相关。我们使用来自英国和爱尔兰的肝移植（LT）受者的国家队列来比较不同移植后时期（“时代”）移植失败的年龄依赖性风险。确定了一组首次肝移植接受者（1995-2016）（11,006）。使用Cox回归来估计不同年龄组（18-29岁、30-39岁、40-49岁、50-59岁和60-76岁）之间移植物损失的风险比（HR），以及移植后不同时期（0-90天、90天- 2年和2-10年）的移植物损失。移植失败的风险在18 - 29岁之间最高（校正风险比1.25,95% CI: 1.00-1.57，P= 0.04），在30-39岁之间最高（校正风险比1.31,95% CI: 1.11-1.55，P= 0.02）。40岁以下患者在移植后90天内移植物衰竭相似，但移植后2-10年更严重（18-29年HR 1.36, 95% CI: 0.96-1.93，P< 0.001）。慢性排斥反应（CR）导致的移植失败在18-29岁的受者中更为常见（P< 0.001）。18岁至39岁之间的成年人移植有后期移植物丢失的风险。CR是年轻人（18-29岁）关注的问题。我们的数据强调了在成人保健中需要专门的青年成人服务。
Graft loss incidence is reported to be inversely related to recipient age. We used a national cohort of liver transplant (LT) recipients from the United Kingdom and Ireland to compare the age‐dependent risk of graft failure in different post‐transplantation time‐periods (‘epochs’). A cohort of first‐time LT recipients (1995–2016) were identified (11 006). Cox regression was used to estimate hazard ratios (HR) comparing graft loss between age‐groups (18–29, 30–39, 40–49, 50–59 and 60–76 years) and graft loss in different post‐transplant epochs: 0–90 days, 90 days–2 years and 2–10 years. The risk of graft failure was highest in those transplanted between age 18 and 29 (adjusted HR 1.25, 95% CI: 1.00–1.57,P= 0.04) and in those aged 30–39 (adjusted HR 1.31, 95% CI: 1.11–1.55,P= 0.02). Graft failure in those under the age of 40 was similar in the first 90 days but worse 2–10 years’ post‐LT (18–29 years HR 1.36, 95% CI: 0.96–1.93,P< 0.001). Graft failure because of chronic rejection (CR) was more common in recipients aged 18–29 (P< 0.001). Adults transplanted between age 18 and 39 are at risk of late graft loss. CR is a concern for young adults (18–29 years). Our data highlights the need for specialist young adult services within adult healthcare.