Functional impairment in older liver transplantation candidates: From the functional assessment in liver transplantation study.
Functional impairment in older liver transplantation candidates: From the functional assessment in liver transplantation study.
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DOI：
10.1002/lt.24334
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Lai JC
中科院分区：
文献类型：
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作者：
Wang CW;Covinsky KE;Feng S;Hayssen H;Segev DL;Lai JC
老年人肝移植的流行导致考虑肝移植（LT）的≥65奥尔兹数量急剧增加。然而，临床医生缺乏客观的措施来对老年患者进行风险分层。我们的目的是确定是否短期身体功能电池（SPPB），一个良好的验证老年人的身体功能的措施，有更大的预后价值，在老年人与年轻的LT候选人。实验室MELD ≥12的LT列出的成人门诊患者使用SPPB进行身体功能测试，包括步态速度、椅子站立和平衡。患者按年龄（“年轻”= <65岁;“老年”= ≥65岁）和SPPB（“受损”= ≤9;“稳健”= >9）分类。竞争风险模型将年龄和SPPB与等待名单死亡/除名相关联。在463例LT候选者中，21% ≥65岁; 18%死亡/除名。年龄较大的患者步态较慢（1.1 vs.1.3 m/sec; p<0.001），椅子站立有较慢的趋势（12.8 vs.11.8 sec; p=0.06），能够完成所有平衡测试的比例较小（65 vs.78%; p=0.01）;年龄较大的患者SPPB低于年轻患者（10 vs.11; p=0.01）。与作为参考组的年轻健壮患者相比，年轻受损患者（HR 1.77; p=0.03）和老年受损患者（HR 2.70; p=0.003）的等待名单死亡风险显著更高，但老年健壮患者的风险无差异（HR 1.38; p=0.35）[等同性检验p=0.01]。调整MELD-Na后，与年轻健康患者相比，仅老年受损患者的等待名单死亡风险增加（HR 2.36; p=0.01）[等同性检验p=0.05]。总之，SPPB评估的功能损害可预测≥ 65岁LT候选者的死亡/除名，与MELD-Na无关。进一步研究基于活动的干预措施，以减少这一人群的不良移植结果是必要的。
The emerging epidemic of older cirrhotics has led to a sharp increase in the number of ≥65 year olds considering liver transplantation (LT). However, clinicians lack objective measures to risk stratify older patients. We aimed to determine whether the Short Physical Performance Battery (SPPB), a well-validated geriatric measure of physical function, has greater prognostic value in older versus younger LT candidates. Adult outpatients listed for LT with laboratory MELD ≥12 underwent physical function testing using the SPPB, consisting of gait speed, chair stands, and balance. Patients were categorized by age (“younger”= <65 years; “older”= ≥65 years) and SPPB (“impaired”= ≤9; “robust”= >9). Competing risks models associated age and SPPB with wait-list death/delisting. Of 463 LT candidates, 21% were ≥65 years; 18% died/delisted. Older patients had slower gait (1.1 vs.1.3m/sec; p<0.001), a trend of slower chair stands (12.8 vs.11.8sec; p=0.06), and a smaller proportion able to complete all balance tests (65 vs.78%; p=0.01); SPPB was lower in older vs. younger patients (10 vs.11; p=0.01). When compared to younger robust patients as a reference group, younger impaired patients (HR 1.77; p=0.03) and older impaired patients (HR 2.70; p=0.003) had significantly higher risk of wait-list mortality, but there was no difference in risk for older robust patients (HR 1.38; p=0.35) [test of equality p=0.01]. After adjustment for MELD-Na, only older impaired patients had an increased risk of wait-list mortality compared to younger robust patients (HR 2.36; p=0.01) [test of equality p=0.05]. In conclusion, functional impairment, as assessed by the SPPB, predicts death/delisting for LT candidates ≥ 65 years independent of MELD-Na. Further research into activity-based interventions to reduce adverse transplant outcomes in this population is warranted.