一项基于UNOS的超高龄供肝移植预后和危险因素分析的队列研究  

UNOS based study for long-term outcomes and risk factors of liver transplantation recipients receiving grafts from donor aged 80 years and over

作　　者：董立彬 王晓波 蔡书奇 汪恺 徐骁 Dong Libin;Wang Xiaobo;Cai Shuqi;Wang Kai;Xu Xiao(Zhejiang University School of Medicine,Hangzhou 310058,China;The Fourth School of Clinical Medicine,Zhejiang Chinese Medical University,Hangzhou,310053,China;Hangzhou Medical College,Hangzhou 310059,China)

机构地区：[1]浙江大学医学院,杭州310058 [2]浙江中医药大学第四临床医学院,杭州310053 [3]杭州医学院,杭州310059

出　　处：《中华器官移植杂志》2024年第6期382-390,共9页Chinese Journal of Organ Transplantation

基　　金：国家重点研发计划(2021YFA1100500);国家自然科学基金重点项目(81930016);浙江省科技厅"尖兵""领雁"研发攻关计划(2022C03108)。

摘　　要：目的探讨超高龄(供者年龄≥80岁)供肝对肝移植术后受者和移植物生存的影响及相关危险因素。方法回顾性分析2002年1月至2023年6月美国器官共享联合网络数据库(United Network for Organ Sharing,UNOS)中肝移植受者的临床诊疗和随访数据。按年龄将供者分为,年龄<60岁的非高龄供者(non-elderly donor,NED)组,60~79岁的高龄供者(elderly donor,ED)组和≥80岁的超高龄供者(very elderly donor,VED)组,并用倾向性评分匹配3组受者以减少基线选择偏移。用Kaplan-Meier法计算生存率,Log-Rank检验比较3组间的生存差异,单因素和多因素Cox等比例回归分析VED组总生存率(overall survival,OS)的独立危险因素。再根据受者年龄分为<50岁、50~69岁和≥70岁3个亚组,比较NED组、ED组和VED组间受者的生存情况。结果经纳排标准筛选后,115089例肝移植受者纳入本次研究。其中,NED组95973例(83.4%),ED组18520例(16.1%),VED组596例(0.5%)。经3∶3∶1倾向性评分匹配后,NED组1623例、ED组1623例、VED组541例,3组基线数据比较,差异无统计学意义。NED组、ED组和VED组10年受者OS分别为61.8%、55.9%和47.8%,10年移植物生存率(graft survival,GS)分别为61.3%、53.8%和45.9%,组间比较,差异均有统计学意义(P值均<0.001)。在<70岁的受者中,VED组10年OS和GS分别为49.0%和47.1%,均明显低于NED组的63.7%和61.8%和ED组的57.7%和55.2%,组间比较,差异均有统计学意义(P值均<0.001);在≥70岁的受者中,NED组10年OS和GS分别为47.2%和48.7%,ED组为47.0%和48.7%,VED组为40.0%和39.2%,组间比较,差异均无统计学意义(P=0.992和0.996)。单因素和多因素Cox回归分析结果显示,冷缺血时间≥8 h(HR=1.447,95%CI:1.088~1.923,P=0.011)、受者移植前依赖重症监护室(intensive care unit,ICU)治疗(HR=1.803,95%CI:1.176~2.765,P=0.007)、受者存在乙型或丙型肝炎病毒感染(HR=1.432,95%CI:1.057~1.941,P=0.020)为影响VED组OS的独立危险因素。结论VED供肝会明显降�Objective To investigate the long-term prognosis of liver transplantation(LT)recipients who received grafts from donors aged≥80 years and the associated risk factors.Methods Clinical and follow-up data of LT recipients from January 2002 to June 2023 were retrospectively analyzed using the United Network for Organ Sharing(UNOS)database.Donors were categorized into three groups:non-elderly donors(NED,age<60 years),elderly donors(ED,age 60-79 years),and very elderly donors(VED,age≥80 years).Propensity score matching(PSM)was used to reduce baseline selection bias among the groups.Survival rates were calculated using the Kaplan-Meier method,and differences among the groups were compared using the Log-Rank test.Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent risk factors for overall survival(OS)in the VED group.Recipients were further subdivided into three age groups(<50 years,50-69 years,and≥70 years)to compare survival outcomes among NED,ED,and VED groups.Results A total of 115,089 LT recipients were included,comprising 95,973(83.4%)in the NED group,18,520(16.1%)in the ED group,and 596(0.5%)in the VED group.After 3∶3∶1 PSM,each group included 1,623 recipients for NED and ED,and 541 for VED,with no significant differences in baseline data.The 10-year OS rates for NED,ED,and VED groups were 61.8%,55.9%,and 47.8%,respectively,and the 10-year graft survival(GS)rates were 61.3%,53.8%,and 45.9%,respectively,with all comparisons showing statistical significance(P<0.001).In recipients aged<70 years,the VED group had significantly lower OS and GS rates(49.0%and 47.1%,respectively)compared to the NED(63.7%and 61.8%)and ED(57.7%and 55.2%)groups(P<0.001).For recipients aged≥70 years,there were no significant differences in 10-year OS and GS among the NED(47.2%and 48.7%),ED(47.0%and 48.7%),and VED(40.0%and 39.2%)groups(P=0.992 and P=0.996,respectively).Cox regression analysis identified cold ischemia time≥8 hours(HR=1.447,95%CI:1.088-1.923,P=0.011),pre-

关 键 词：肝移植 高龄老人 老年供肝 预后 危险因素 

分 类 号：R657.3[医药卫生—外科学]