Factors predicting futility of liver transplant in elderly recipients:A single-center experience
作者机构：Department of Internal MedicineCleveland Clinic FoundationClevelandOH 44195United States Department of General SurgeryCleveland Clinic FoundationClevelandOH 44195United States Department of Gastroenterology&HepatologyCleveland Clinic FoundationClevelandOH 44195United States
出 版 物：《World Journal of Transplantation》 (世界移植杂志)
年 卷 期：2021年第11卷第10期
页 面：421-431页
学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学]
主 题：Liver transplantation Liver cirrhosis Heart failure Diastolic Medical futility Liver diseases Organ transplantation
摘 要：BACKGROUND As the population of the United States ages,there has been an increasing number of elderly patients with cirrhosis listed for *** studies have shown variable results in terms of the relative survival benefit for elderly liver transplant(LT)*** may be factors that are associated with a poor post-transplant outcome which may help determine which elderly patients should and should not be listed for *** To identify factors associated with futility of transplant in elderly *** This was a retrospective study of all patients above the age of 45 who underwent liver transplantation at our tertiary care center between January 2010 and March 2020(n=1019).“Elderlywas defined as all patients aged 65 years and *** outcome was defined as death within 90 d of *** regression analysis was performed to determine what variables,if any were associated with futile outcome in elderly *** outcomes such as one year mortality and discharge to facility(such as skilled nursing facility or long-term acute care hospital)were analyzed in the entire sample,compared across three age groups(45-54,55-64,and 65+years).RESULTS There was a total of 260 elderly patients who received LT in the designated time period.A total of 20 patients met the definition of“futile*** mean Model of End-Stage Liver Disease scores in the futile and non-futile group were not significantly different(21.78 in the futile group vs 19.66 in the“non-futilegroup).Of the variables tested,only congestive heart failure was found to have a statistically significant association with futile outcome in LT recipients over the age of 65(P=0.001).Of these patients,all had diastolic heart failure with normal ejection fraction and at least grade I diastolic dysfunction as measured on *** aged 65 years and older were more likely to have the outcomes of death within 1 year of LT[hazard ratio:1.937,confidence interval(C
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