Survival benefit of accepting livers from deceased donors over 70 years old

被引:29
作者
Haugen, Christine E. [1 ]
Bowring, Mary G. [1 ]
Holscher, Courtenay M. [1 ]
Jackson, Kyle R. [1 ]
Garonzik-Wang, Jacqueline [1 ]
Cameron, Andrew M. [1 ]
Philosoph, Benjamin [1 ]
McAdams-DeMarco, Mara [1 ,2 ]
Segev, Dorry L. [1 ,2 ,3 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA
[2] Johns Hopkins Sch Publ Hlth, Dept Epidemiol, Baltimore, MD 21205 USA
[3] Sci Registry Transplant Recipients, Minneapolis, MN 55415 USA
关键词
clinical research; practice; donors and donation; deceased; extended criteria; liver transplantation; hepatology; organ acceptance; Scientific Registry for Transplant Recipients (SRTR); D-MELD; RISK; TRANSPLANTATION; ORGAN; FAILURE; OFFERS; AGE;
D O I
10.1111/ajt.15250
中图分类号
R61 [外科手术学];
学科分类号
摘要
Livers from older donors (OLDs; age >= 70) are risky and often declined; however, it is likely that some candidates will benefit from OLDs versus waiting for younger ones. To characterize the survival benefit of accepting OLD grafts, we used 2009-2017 SRTR data to identify 24 431 adult liver transplant (LT) candidates who were offered OLD grafts eventually accepted by someone. Outcomes from the time-of-offer were compared between candidates who accepted an OLD graft and matched controls within MELD +/- 2 who declined the same offer. Candidates who accepted OLD grafts (n = 1311) were older (60.5 vs. 57.8 years, P < .001), had a higher median MELD score (25 vs. 22, P < .001), and were less likely to have hepatitis C cirrhosis (14.9% vs. 31.2%, P < .001). Five-year cumulative mortality among those who accepted versus declined the same OLD offer was 23.4% versus 41.2% (P < .001). Candidates who accepted OLDs experienced an almost twofold reduction in mortality (aHR:(0.45)0.52(0.59), P < .001) compared to those who declined the same offer, especially among the highest MELD (35-40) candidates (aHR:(0.10)0.24(0.55), P = .001). Accepting an OLD offer provided substantial long-term survival benefit compared to waiting for a better organ offer, notably among candidates with MELD 35-40. Providers should consider these benefits as they evaluate OLD graft offers.
引用
收藏
页码:2020 / 2028
页数:9
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