Outcomes of Liver Transplantation Among Older Recipients With Nonalcoholic Steatohepatitis in a Large Multicenter US Cohort: the Re-Evaluating Age Limits in Transplantation Consortium.
Outcomes of Liver Transplantation Among Older Recipients With Nonalcoholic Steatohepatitis in a Large Multicenter US Cohort: the Re-Evaluating Age Limits in Transplantation Consortium.
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DOI：
10.1002/lt.25863
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Re-Evaluating Age Limits in Transplantation (REALT) Consortium
中科院分区：
文献类型：
--
作者：
Kwong AJ;Devuni D;Wang C;Boike J;Jo J;VanWagner L;Serper M;Jones L;Sharma R;Verna EC;Shor J;German MN;Hristov A;Lee A;Spengler E;Koteish AA;Sehmbey G;Seetharam A;John N;Patel Y;Kappus MR;Couri T;Paul S;Salgia RJ;Nhu Q;Frenette CT;Lai JC;Goel A;Re-Evaluating Age Limits in Transplantation (REALT) Consortium
肝移植(LT)人群正在老龄化，非酒精性脂肪性肝炎(NASH)患病率的增长推动了对移植的需求。患有NASH的老年肝移植受者在肝移植后不良结局的风险可能增加。我们的目标是在一个大的多中心队列中描述这些接受者的结果。包括2010年至2016年在重新评估移植年龄限制(REALT)联盟中的13个中心的所有初级LT接受者≥65岁。在1023例肝移植受者中，226例(22.1%)年龄在70岁以上，207例(20.2%)有NASH。与其他接受肝移植的患者相比，NASH接受者年龄更大(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%)，在肝移植中有更高的终末期肝病模型-钠(21比18)(P<；0.05)。有或无慢性并发症的糖尿病(69.6%)、高血压(66.3%)、高脂血症(46.3%)、冠状动脉疾病(36.7%)和中、重度肾脏疾病(44.4%)等特殊心脏危险因素在NASH LT受者中高发。NASH患者1年和3年的移植物存活率分别为90.3%和82.4%，而非NASH患者的1年和3年存活率分别为88.9%和80.4%(对数等级P=0.58和P=0.59)。移植后1年内，移植排斥反应发生率(17.4%)、胆道狭窄发生率(20.9%)和实体器官癌发生率(4.9%)相似。两组心血管(CV)并发症、肾功能衰竭和感染的发生率也相似。我们观察到NASH和非NASH移植受者的移植后发病率和死亡率结果相似。某些心血管危险因素在这一人群中更为普遍，尽管移植后1年内的结果，包括心血管事件和肾功能衰竭，与非NASH LT接受者相似。
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.
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影响因子：
12.6
作者：
Nagai, Shunji;Collins, Kelly;Moonka, Dilip
通讯作者：
Moonka, Dilip
DOI：
10.1111/liv.12872
发表时间：
2015-12
期刊：
Liver international : official journal of the International Association for the Study of the Liver
影响因子：
--
作者：
VanWagner LB;Lapin B;Skaro AI;Lloyd-Jones DM;Rinella ME
通讯作者：
Rinella ME
影响因子：
8.8
作者：
Kwong, A.;Kim, W. R.;Kasiske, B. L.
通讯作者：
Kasiske, B. L.
影响因子：
25.7
作者：
Targher, Giovanni;Byrne, Christopher D.;Barbui, Corrado
通讯作者：
Barbui, Corrado
影响因子：
29.4
作者：
Su, Feng;Yu, Lei;Ioannou, George N.
通讯作者：
Ioannou, George N.