接受老年供体肝脏移植可降低死亡风险

StephenW

Offer acceptance of older donor liver for transplant lowers mortality risk
October 22, 2018

Patients with advanced liver disease who accept donor livers from individuals older than 70 years significantly reduced their long-term mortality risk compared with similar patients who declined the same offer regardless of MELD score, according to data presented at the American College of Surgeons Clinical Congress 2018.

“Some surgeons are reluctant to use livers from older donors because they are reluctant to use these organs in high MELD score candidates,” Christine Haugen, MD, lead study author from Johns Hopkins Hospital in Baltimore, Maryland, said in a press release. “We demonstrate that if you get an offer from an older donor, you should probably consider accepting the organ, because there is now a demonstrated survival benefit in doing so.”

Haugen and colleagues analyzed data from the Scientific Registry of Transplant Recipients and included all adult liver transplant candidates who were offered livers between 2009 and 2017 from donors older than 70 years in the study.

They found 1,383 waitlist candidates who accepted a liver from an older patient and 29,142 who declined a similar offer.

Using matched population groups based on MELD scores, Haugen and colleagues found that waitlist candidates who accepted an offer from an older donor had a 61% lower mortality risk compared with those who declined the offer.

“Our primary finding is that regardless of MELD score — that is the 15 to 40 range — there was nearly a twofold decrease in mortality beyond 90 days with acceptance of an older donor,” Haugen said in the release.

Specifically, patients with a MELD score between 29 and 34 had a 60% lower mortality risk, those between 23 and 28 had a 43% lower risk, and those between 15 and 22 had a 56% lower risk.

“The main takeaway is that accepting an older donor confers survival benefits for waitlist candidates across the full range of MELD scores,” Haugen said in the release. “Surgeons should be aware of the consequences of declining an older liver donor for patients with any MELD score. After declining an older donor, you don’t know if a candidate is going to get an offer from another donor. And unfortunately, up to one fourth of these patients will end up dying without ever receiving a transplant.” – by Talitha Bennett

Disclosure: Healio Gastroenterology and Liver Disease was unable to determine the authors’ relevant financial disclosures at the time of publication.

StephenW

接受老年供体肝脏移植可降低死亡风险
2018年10月22日

根据美国外科医师学会临床大会2018年提供的数据，与不同MELD评分相似的患者相比，接受70岁以上个体捐赠肝脏的晚期肝病患者的长期死亡风险显着降低。

马里兰州巴尔的摩市约翰霍普金斯医院的主要研究作者，医学博士Christine Haugen在新闻发布会上说：“一些外科医生不愿意使用老年捐赠者的肝脏，因为他们不愿在高MELD评分候选者中使用这些器官。” “我们证明，如果你得到老年捐赠者的报价，你应该考虑接受这个器官，因为现在这样做可以证明生存有益。”

Haugen及其同事分析了移植受体科学登记处的数据，包括所有成年肝移植候选人，他们在2009年至2017年期间从70岁以上的捐赠者中获得了肝脏。

他们发现有1,383名等候名单候选人接受了一位老年患者的肝脏，而29,142名候选人拒绝了同样的报价。

使用基于MELD分数​​的匹配人群，Haugen及其同事发现，接受旧捐赠者提议的候选人候选人的死亡风险比拒绝提供者低61％。

“我们的主要发现是，无论MELD评分是多少 - 即15到40范围 - 接受老年捐赠者后，死亡率几乎会超过90天，”Haugen在发布时表示。

具体而言，MELD评分在29到34之间的患者的死亡风险降低了60％，23到28岁的患者的风险降低了43％，15到22岁的患者风险降低了56％。

“最主要的一点是，接受一位年长的捐赠者可以在整个MELD评分范围内为候补名单候选人提供生存福利，”Haugen在发布会上表示。 “外科医生应该意识到老年肝脏供体下降对任何MELD评分患者的影响。在拒绝一位年长的捐赠者之后，你不知道候选人是否会得到另一位捐赠者的报价。不幸的是，多达四分之一的患者最终会在没有接受移植手术的情况下死亡。“ - Talitha Bennett

披露：Healio Gastroenterology和Liver Disease无法确定作者在发表时的相关财务披露。