共 25 条
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.
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页码:2020 / 2028
页数:9
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