Aging of Liver Transplant Registrants and Recipients: Trends and Impact on Waitlist Outcomes, Post-Transplantation Outcomes, and Transplant-Related Survival Benefit
Aging of Liver Transplant Registrants and Recipients: Trends and Impact on Waitlist Outcomes, Post-Transplantation Outcomes, and Transplant-Related Survival Benefit
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DOI：
10.1053/j.gastro.2015.10.043
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发表时间：
2016-02-01
期刊：
影响因子：
29.4
通讯作者：
Ioannou, George N.
中科院分区：
文献类型：
--
作者：
Su, Feng;Yu, Lei;Ioannou, George N.
背景与目的：流行病学因素增加了老年患者对肝移植的需求。我们的目的是描述肝移植登记者和接受者的年龄趋势，以及年龄对等待名单和移植后结果以及移植相关生存获益的影响。方法：采用正交设计法我们从器官共享联合网络获得了2002年至2014年在美国进行肝移植（N = 122，606）或接受肝移植（N = 60，820）的成年人的数据。竞争风险分析用于模拟等待名单结果，考克斯比例风险分析用于模拟移植后生存。这些模型还用于估计不同年龄组的5年移植相关生存益处，计算为等待名单和移植后预期寿命之间的差异。研究结果：在2002年至2014年期间，肝移植登记者的平均年龄从51.2岁增加到55.7岁，其中丙型肝炎病毒阳性（50.9 - 57.9岁）的增加比丙型肝炎病毒阴性（51.3 - 54.3岁）登记者更显着。60岁以上登记者的比例从19%增加到41%。在丙型肝炎病毒阴性患者中，肝细胞癌或非酒精性脂肪性肝炎患者比例的增加推动了衰老趋势。在移植登记者中，年龄的增加与移植前死亡率的增加和移植可能性的降低有关。在移植受者中，年龄的增加与移植后死亡率的增加有关。具有相同终末期肝病模型评分的不同年龄组之间的5年移植相关生存获益差异不大。结论：从2002年到2014年，由于丙型肝炎病毒阳性队列的老龄化以及非酒精性脂肪性肝炎和肝细胞癌患病率的增加，肝移植登记者和接受者的年龄急剧老化。增加年龄并不影响移植相关的生存利益，因为年龄减少移植后生存和等待名单生存几乎相等。
BACKGROUND & AIMS: Epidemiologic factors have generated increased demand for liver transplantation among older patients. We aimed to describe trends in age among liver transplant registrants and recipients and the effect of age on waitlist and post-transplantation outcomes and on transplant-related survival benefit. METHODS: We obtained data from the United Network for Organ Sharing on adults who were listed for liver transplantation (N = 122,606) or underwent liver transplantation (N = 60,820) from 2002 to 2014 in the United States. Competing risks analysis was used to model waitlist outcomes and Cox proportional hazards analysis to model post-transplantation survival. These models were also used to estimate 5-year transplant-related survival benefit for different age groups, calculated as the difference between waitlist and post-transplantation life expectancy. RESULTS: Between 2002 and 2014, the mean age of liver transplant registrants increased from 51.2 to 55.7 years, with a more prominent increase in hepatitis C virus-positive (50.9 - 57.9 years) than hepatitis C virus-negative (51.3 - 54.3 years) registrants. The proportion of registrants aged >= 60 years increased from 19% to 41%. In hepatitis C virus-negative patients, aging trends were driven by increasing proportions of patients with hepatocellular carcinoma or nonalcoholic steatohepatitis. Among transplant registrants, increasing age was associated with increasing mortality before transplantation and decreasing likelihood of transplantation. Among transplant recipients, increasing age was associated with increasing post-transplantation mortality. There was little difference in 5-year transplant-related survival benefit between different age groups who had the same Model for EndStage Liver Disease score. CONCLUSIONS: Dramatic aging of liver transplant registrants and recipients occurred from 2002 to 2014, driven by aging of the hepatitis C virus - positive cohort and increased prevalence of nonalcoholic steatohepatitis and hepatocellular carcinoma. Increasing age does not affect transplant-related survival benefit substantially because age diminishes both post-transplantation survival and waitlist survival approximately equally.