Differential aging trends among candidates for liver transplant with and without HCC.

IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Gabrielle Jutras, Neil Mehta, Jennifer C Lai
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Abstract

HCC has become a leading indication for liver transplant (LT), with HCC registrants increasing more than 6-fold in the past 2 decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older patients with HCC are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger patients with HCC, and patients without HCC. All adult candidates for LT (18+) in the UNOS/OPTN registry (2012-2022) were analyzed and categorized by HCC status and age (<70 or 70+). Regression coefficients compared HCC and non-HCC registrants and recipients by age group. The aging trend among LT registrants was more pronounced in patients with HCC. From 2012 to 2022, the mean age of HCC registrants rose from 58.7 to 62.9, with those aged 70+ increasing from 4.2% to 15.0%. Non-HCC registrants saw minimal change, with a stable mean age of 53 years and a modest rise in those 70+ from 2.1% to 4.7%. HCV prevalence among patients with HCC decreased from 37.5% to 27.4%, while patients without HCC dropped from 14.8% to 5%. Posttransplant outcomes for older HCC recipients remained favorable, with 1-year and 5-year survival rates of 91% and 71%, respectively, comparable to older patients without HCC (87% and 69%). Among over 132,000 LT registrants from 2012 to 2022, the age of HCC candidates increased, with a growing proportion aged 70 and older, while the age and proportion of older adults among non-HCC registrants remained stable. This demographic shift underscores the importance of enhanced frailty assessments to improve outcomes for older patients with HCC.

肝移植候选者伴和不伴肝细胞癌的不同衰老趋势。
背景:肝细胞癌(HCC)已成为肝移植(LT)的主要适应症,HCC登记患者在过去二十年中增加了六倍以上,同时伴有老年候选者的显著增加。鉴于这一趋势和丙型肝炎(HCV)治疗的影响,需要有关老年HCC患者衰老和病因变化的最新数据。本研究通过比较老年(70岁以上)、年轻HCC患者和非HCC患者,探讨了年龄趋势、临床特征和移植结果。方法:对UNOS/OPTN登记(2012-2022)中所有18岁以上的成人肝移植患者进行分析,并按HCC状态和年龄进行分类(结果:肝移植登记患者的老龄化趋势在HCC患者中更为明显)。从2012年到2022年,HCC登记的平均年龄从58.7岁上升到62.9岁,70岁以上的人从4.2%上升到15.0%。非hcc登记者的变化最小,平均年龄稳定在53岁,70岁以上的人从2.1%小幅上升到4.7%。HCC患者的HCV患病率从37.5%下降到27.4%,而非HCC患者的HCV患病率从14.8%下降到5%。老年HCC受者的移植后结果仍然良好,1年和5年生存率分别为91%和71%,与老年非HCC患者(87%和69%)相当。结论:在2012 - 2022年超过13.2万名肝移植登记者中,HCC候选人群年龄增加,年龄在70岁及以上的比例越来越大,而非HCC登记者中老年人的年龄和比例保持稳定。这种人口结构的转变强调了加强虚弱评估以改善老年HCC患者预后的重要性。
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来源期刊
Liver Transplantation
Liver Transplantation 医学-外科
CiteScore
7.40
自引率
6.50%
发文量
254
审稿时长
3-8 weeks
期刊介绍: Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD, Liver Transplantation delivers current, peer-reviewed articles on liver transplantation, liver surgery, and chronic liver disease — the information necessary to keep abreast of this evolving specialty.
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