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Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States

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World Journal of Hepatology 2023年第4期15卷 554-563页

作者： Inkyu S Lee Kenji Okumura Ryosuke Misawa Hiroshi Sogawa gregory veillette Devon John Thomas Diflo Seigo Nishida Abhay Dhand Department of Surgery Westchester Medical CenterValhallaNY 10595United States Department of Medicine Westchester Medical CenterValhallaNY 10595United States

BACKGROUND Early in the coronavirus disease 2019(COVID-19)pandemic,there was a significant impact on routine medical care in the United States,including in fields of transplantation and *** To analyze the impact and outcomes of early COVID-19 pandemic on liver transplantation(LT)for hepatocellular carcinoma(HCC)in the United *** WHO declared COVID-19 as a pandemic on March 11,*** retrospectively analyzed data from the United Network for Organ Sharing(UNOS)database regarding adult LT with confirmed HCC on explant in 2019 and *** defined pre-COVID period from March 11 to September 11,2019,and early-COVID period as from March 11 to September 11,*** Overall,23.5%fewer LT for HCC were performed during the COVID period(518 vs 675,P<0.05).This decrease was most pronounced in the months of March-April 2020 with a rebound in numbers seen from May-July *** LT recipients for HCC,concurrent diagnosis of non-alcoholic steatohepatitis significantly increased(23 vs 16%)and alcoholic liver disease(ALD)significantly decreased(18 vs 22%)during the COVID *** age,gender,BMI,and MELD score were statistically similar between two groups,while waiting list time decreased during the COVID period(279 days vs 300 days,P=0.041).Among pathological characteristics of HCC,vascular invasion was more prominent during COVID period(P<0.01),while other features were the *** the donor age and other characteristics remained same,the distance between donor and recipient hospitals was significantly increased(P<0.01)and donor risk index was significantly higher(1.68 vs 1.59,P<0.01)during COVID *** outcomes,90-day overall and graft survival were the same,but 180-day overall and graft were significantly inferior during COVID period(94.7 vs 97.0%,P=0.048).On multivariable Coxhazard regression analysis,COVID period emerged as a significant risk factor of post-transplant mortality(Hazard ratio 1.85;95%CI:1.28-2.68,P=0.001).CONCLUSION Durin

关键词： Liver transplantation Hepatocellular carcinoma COVID-19 Mortality Graft failure United Network for Organ Sharing database

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Trends and outcomes of liver transplantation among older recipients in the United States

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World Journal of Transplantation 2022年第8期12卷 259-267页

作者： Kenji Okumura Joon Sub Lee Abhay Dhand Hiroshi Sogawa gregory veillette Devon John Ryosuke Misawa Roxana Bodin David C Wolf Thomas Diflo Seigo Nishida Department of Surgery Westchester Medical Center/New York Medical CollegeValhallaNY 10595United States

BACKGROUND The average age of recipients and donors of liver transplantation(LT)is *** there has been a change in the indications for LT over the years,data regarding the trends and outcomes of LT in the older population is *** To assess the clinical characteristics,age-related trends,and outcomes of LT among the older population in the United *** We analyzed data from the United Network for Organ Sharing database between *** sample was split into younger group(18-64 years old)and older group(≥65 years old).RESULTS Between 1987-2019,155758 LT were performed in the United *** this period there was a rise in median age of the recipients and percentage of LT recipients who were older than 65 years increased(P<0.05)with the highest incidence of LT among older population seen in 2019(1920,23%).Common primary etiologies of liver disease leading to LT in older patients when compared to the younger group,were non-alcoholic steatohepatitis(16.4%vs 5.9%),hepatocellular carcinoma(14.9%vs 6.9%),acute liver failure(2.5%vs 5.2%),hepatitis C cirrhosis(HCV)(19.2%vs 25.6%)and acute alcoholic hepatitis(0.13%vs 0.35%).In older recipient group female sex and Asian race were higher,while model for end-stage liver disease(MELD)score and rates of preoperative mechanical ventilation were lower(P<0.01).Median age of donor,female sex,body mass index(BMI),donor HCV positive status,and donor risk index(DRI)were significantly higher in older group(P<0.01).In univariable analysis,there was no difference in post-transplant length of hospitalization,one-year,three-year and five-year graft survivals between the two *** multivariable Cox-Hazard regression analysis,older group had an increased risk of graft failure during the five-year post-transplant period(hazard ratio:1.27,P<0.001).Other risk factors for graft failure among recipients were male sex,African American race,re-transplantation,presence of diabetes,mechanical ventilation at th

关键词： Liver transplant Elderly Outcomes Hepatocellular carcinoma Nonalcohol steatohepatitis

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