Liver transplantation in patients over 60 and 65 years: an evaluation of long-term outcomes and survival
Liver transplantation in patients over 60 and 65 years: an evaluation of long-term outcomes and survival
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DOI：
10.1002/lt.21181
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发表时间：
2007-10-01
影响因子：
4.6
通讯作者：
Heneghan, Michael A.
中科院分区：
文献类型：
--
作者：
Cross, Timothy J. S.;Antoniades, Charalambos G.;Heneghan, Michael A.
随着肝移植（LT）需求的增加，老年受者的结局受到了更严格的审查，因为以前的研究表明生存结局较差。将1988年至2003年在伦敦国王学院医院接受移植的77例年龄> 65岁的患者（第1组）的结果与年龄在60 - 64岁之间的所有受者（第2组，n = 137）和202例年龄在18-59岁之间的时间匹配的慢性肝病对照患者（第3组）进行比较。第1、2和3组的30天患者生存率分别为99%、94%和94%（P =不显著[NS]）。1年时，3组患者的生存率分别为82%、86%和83%（P = NS），5年时患者的生存率相当（分别为73%、80%和78%）（P = NS）。年龄较大的队列中急性细胞排斥（ACR）的发生率较低（43% vs. 45% vs. 61%，P = 0.0016），但各组发生ACR的患者数量无显著差异（P = 0.16）。两组间慢性排斥反应的发生率有相似但不显著的趋势。总之，这些数据表明，超过60和65岁的患者接受LT的生存率是令人满意的，至少在移植后的第一个5年。此外，65岁以上的患者排斥反应较少，移植物存活率良好。因此，一旦进行了合并症的全面筛查，不应仅根据年龄拒绝对>65岁的患者进行LT。
With increased demand for liver transplantation (LT), outcomes of older recipients have been subjected to greater scrutiny, as previous studies have demonstrated poorer survival outcomes. Outcomes of 77 patients aged > 65 yr (group 1) who underwent transplantation between 1988 and 2003 at King's College Hospital, London, were compared with all recipients aged between 60 and 64 yr (group 2, n = 137) and 202 time-matched control patients with chronic liver disease aged between 18-59 yr (group 3). Patient survival at 30-days for groups 1, 2, and 3 were 99%, 94%, and 94%, respectively (P = not significant [NS]). At 1 -yr, survival in the 3 groups was 82%, 86%, and 83%, respectively (P = NS), and at 5-yr patient survival was comparable (73%, 80%, and 78%, respectively) (P = NS). Episodes of acute cellular rejection (ACR) were fewer in the older cohorts (43% vs. 45% vs. 61%, P = 0.0016), although there was no significant difference identified in the numbers of patients in each group who experienced ACR (P = 0.16). A similar but nonsignificant trend was identified for rates of chronic rejection among the groups. In conclusion, these data suggest that survival of patients over 60 and 65 yr undergoing LT is satisfactory, at least in the first 5-yr posttransplantation. In addition, patients over 65 yr experience less rejection, with good graft survival. Thus, LT should not be denied to patients >65 yr on the basis of age alone, once a comprehensive screen for comorbidity has been undertaken.