Liver transplant recipients older than 60 years have lower survival and higher incidence of malignancy
Liver transplant recipients older than 60 years have lower survival and higher incidence of malignancy
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DOI：
10.1046/j.1600-6143.2003.00227.x
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发表时间：
2003-11-01
影响因子：
8.8
通讯作者：
Prieto, J
中科院分区：
文献类型：
--
作者：
Herrero, JI;Lucena, JF;Prieto, J
年龄较大并不是肝移植的禁忌症，但与年龄相关的发病率可能是死亡的原因。在111例成人肝移植受者中评估了存活率和主要移植后并发症的发生率。根据年龄分为两组（60岁以下患者，n = 54; 60岁以上患者，n = 57），并对两组进行比较。年龄较大的患者更常因丙型肝炎（p = 0.03）和肝细胞癌（p = 0.05）而接受移植，并且他们的肝脏疾病较不严重（Child-Pugh和MELD评分显著较低;分别为p = 0.004和p = 0.05）。移植后，老年患者的生存率显著降低（p = 0.02）。较高的年龄与死亡率独立相关（每增加10年的风险比：2.1; 95%置信区间：1.1-4.0; p = 0.02）。老年患者中新发肿瘤和非皮肤肿瘤的发生率较高（分别为p = 0.02和p = 0.007）。1例60岁以下患者和12例60岁以上患者的死亡原因为结核病（p = 0.002）。在多变量分析中，较高的年龄和吸烟与较高的新发肿瘤死亡风险独立相关。总之，老年肝移植受者的生存率明显低于年轻患者。这是导致存活率下降的原因。
Older age is not considered a contraindication for liver transplantation, but age-related morbidity may be a cause of mortality. Survival and the incidence of the main post-transplant complications were assessed in 111 adult liver transplant recipients. They were divided in two groups according to their age (patients younger than 60 years, n = 54; patients older than 60 years, n = 57) and both groups were compared. Older patients were more frequently transplanted for hepatitis C (p = 0.03) and hepatocellular carcinoma (p = 0.05) and their liver disease was less advanced (Child-Pugh and MELD scores were significantly lower; p = 0.004 and p = 0.05, respectively). After transplantation, older patients had a significantly lower survival (p = 0.02). Higher age was independently associated with mortality (hazard ratio for each 10-year increase: 2.1; 95% confidence interval: 1.1-4.0; p = 0.02). The incidence of de novo neoplasia and nonskin neoplasia were higher in older patients (p = 0.02 and p = 0.007, respectively). Malignancy was the cause of death in one patient younger than 60 years and in 12 patients older than 60 years (p = 0.002). In multivariate analysis, a higher age and smoking were independently associated with a higher risk of dying of de novo neoplasia. In conclusion, older liver transplant recipients have a significantly lower survival than younger patients. Malignancy is responsible for this decreased survival.