急性-慢性肝衰竭患者年龄与肝移植预后的关系

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-04-22 DOI:10.1016/j.jss.2025.03.013

Jie Zhou MD , Siyao Zhang MM , Jingxia Liu BS , Jiawei Ding MM , Shenli Ren MSc , Tao Zhang MM , Danni Ye MM , Fangshen Xu MM , Zheng Chen MM , Huilin Zheng PhD , Lei Zhang PhD , Yu Zhang MD , Zhenhua Hu MD

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引用次数: 0

摘要

导读：材料和方法我们评估了2007年1月1日至2018年6月30日期间在移植受者科学登记数据库中登记为LT的成年候选者。根据患者上市时的年龄将其分为四组：I组（≤34岁）、II组（35-49岁）、III组（50-64岁）和IV组（≥65岁）。对 ACLF 分级（EST-ACLF）进行了估计，并评估了意向治疗生存率、总生存率（OS）以及 OS 的潜在预测因素。在I组中，ACLF等级之间的OS无差异，但在II-IV组中，ACLF等级越高，OS越低。多变量分析显示年龄（P < 0.001，参考第一组；第二组危险比 0.995，P = 0.936；第三组 1.196，P = 0.002；第四组 1.651，P < 0.001）和EST-ACLF分级（P < 0.001，参考EST-ACLF-0；EST-ACLF-1为1.214，P < 0.001；EST-ACLF-2为1.246，P < 0.001；EST-ACLF-3为1.578，P < 0.001）是OS的独立预测因子。结论前交叉韧带分级高的年轻患者与分级低的患者相比，可获得相似的OS。前交叉韧带纤维分级较高的老年患者在LT术后的预后较差。

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The Association of Age and Liver Transplant Outcomes in Patients With Acute-On-Chronic Liver Failure

Introduction

To explore the role of age at listing on outcomes for patients with acute-on-chronic liver failure (ACLF) awaiting liver transplantation (LT).

Materials and methods

We assessed adult candidates listed for LT in the Scientific Registry of Transplant Recipients database from January 1, 2007 to June 30, 2018. Patients were divided into four groups based on age at listing: I (≤34), II (35-49), III (50-64), and IV (≥65). The ACLF grade was estimated (est-ACLF), and intent-to-treat survival, overall survival (OS), as well as potential predictors for OS was evaluated.

Results

Est-ACLF-3 was associated with a higher 30-d cumulative dropout rate and inferior intent-to-treat survival across age groups. No difference was observed in OS among ACLF grades in group I, but significantly inferior OS was observed in higher ACLF grades in groups II-IV. Multivariate analysis showed age (P < 0.001, ref. group I; hazard ratio 0.995 for group II, P = 0.936; 1.196 for group III, P = 0.002; 1.651 for group IV, P < 0.001) and est-ACLF grade (P < 0.001, ref. est-ACLF-0; 1.214 for est-ACLF-1, P < 0.001; 1.246 for est-ACLF-2, P < 0.001; 1.578 for est-ACLF-3, P < 0.001) were independent predictors for OS. Generalized additive model showed different association between age and OS among different ACLF grades.

Conclusions

Young patients with high ACLF grades could achieve similar OS compared with those with low grades. Elderly patients with higher ACLF grades were associated with inferior outcomes after LT.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.