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75岁以上:肝脏移植中的移植分配和器官效用影响

Miho Akabane¹, Allison Kwong², Yuki Imaoka¹

¹Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA.

Transplantation direct

|October 3, 2024

概括

肝移植 (LT) 对75岁及以上的患者提供生存益处,但器官效用是令人担忧的. 重新考虑分配策略,比如将老年捐赠者与老年接受者匹配,可能会优化稀缺的捐赠肝脏.

科学领域:

肝病学肝病学是一种肝病学.
移植医学移植医学
老年医学老年医学

背景情况:

全球人口老龄化增加了对肝移植 (LT) 的需求.
供体短缺加剧了关于老年候选人 (≥75岁) 的LT的辩论.
这项研究评估了LT在这个人口群体中的生存益处和器官效用.

研究的目的:

评估75岁及以上的候选人肝移植的生存结果.
评估将捐赠肝脏分配给这个特定年龄组的器官效用.
为老年接受者提供肝脏分配策略的潜在改进信息.

主要方法:

从美国器官共享网络数据库 (2003-2022) 中分析了178,469名成年LT候选人.
跨年龄段的后LT生存率和等待名单中断率的比较.
多变量考克斯回归和模拟建模用于预后指标和器官效用.

主要成果:

75岁以上的343名候选人接受了LT;90天的存活率与年轻人群相比.
75岁以上的年龄是3年移植存活期的负预后指标 (HR: 1.72).
等候名单中断率很高 (35.1%在3年);器官效用并不有利于这个年龄组.

结论:

肝移植为75岁及以上的患者提供了生存益处.
目前的器官分配系统可能需要进行调整,以优化稀缺的供体肝脏的使用.
将年长的捐赠者与年长的接受者相匹配可能是改善器官效用的一种策略.

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