AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with dono...AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with donors ≥ 70 years old(study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old(control group).RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus(HCV)-positivity [hazard ratio(HR) = 2.35; 95% confidence interval(CI): 1.55-3.56; P = 0.00]; recipient age(HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease(D-MELD)(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium(HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD(donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients(77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.展开更多
The coronavirus disease 2019(COVID-19)pandemic has profoundly impacted liver transplant(LT)activity across the world,with notable decreases in the number of donations and procedures in most Western countries,in partic...The coronavirus disease 2019(COVID-19)pandemic has profoundly impacted liver transplant(LT)activity across the world,with notable decreases in the number of donations and procedures in most Western countries,in particular throughout the first wave.The cumulative incidence of COVID-19 in LT recipients(with estimates ranging from 0.34%to 1.56%)appears to be at least comparable to that observed for the general population.Clinical and radiological features at presentation are also similar to non-transplant patients.The risk of death among LT recipients requiring hospital admission is high(from 12% to 19%),although some authors have suggested that overall mortality may be actually lower compared to the general non-transplant population.It is likely that these poor outcomes may be mainly influenced by the older age and higher comorbidity burden of LT recipients,rather than by the transplant status itself.In fact,it has been hypothesized that post-transplant immunosuppression would exert a protective role,with special focus on tacrolimus-containing regimens.There is scarce evidence to guide the optimal management of post-transplant COVID-19 and the use of antiviral or immunomodulatory therapies,although both clinical practice and guidelines support the dose reduction or withdrawal of anti-proliferative agents such as mofetil mycophenolate.Preliminary reports suggest that the antibody response to messenger RNA vaccines is significantly impaired as compared to non-immunocompromised individuals,in line with other transplant populations.Finally,it is foreseeable that the future will be conditioned by the emerging variants of severe acute respiratory syndrome coronavirus 2 with increased transmissibility among LT recipients.展开更多
文摘AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with donors ≥ 70 years old(study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old(control group).RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus(HCV)-positivity [hazard ratio(HR) = 2.35; 95% confidence interval(CI): 1.55-3.56; P = 0.00]; recipient age(HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease(D-MELD)(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium(HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD(donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients(77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.
文摘The coronavirus disease 2019(COVID-19)pandemic has profoundly impacted liver transplant(LT)activity across the world,with notable decreases in the number of donations and procedures in most Western countries,in particular throughout the first wave.The cumulative incidence of COVID-19 in LT recipients(with estimates ranging from 0.34%to 1.56%)appears to be at least comparable to that observed for the general population.Clinical and radiological features at presentation are also similar to non-transplant patients.The risk of death among LT recipients requiring hospital admission is high(from 12% to 19%),although some authors have suggested that overall mortality may be actually lower compared to the general non-transplant population.It is likely that these poor outcomes may be mainly influenced by the older age and higher comorbidity burden of LT recipients,rather than by the transplant status itself.In fact,it has been hypothesized that post-transplant immunosuppression would exert a protective role,with special focus on tacrolimus-containing regimens.There is scarce evidence to guide the optimal management of post-transplant COVID-19 and the use of antiviral or immunomodulatory therapies,although both clinical practice and guidelines support the dose reduction or withdrawal of anti-proliferative agents such as mofetil mycophenolate.Preliminary reports suggest that the antibody response to messenger RNA vaccines is significantly impaired as compared to non-immunocompromised individuals,in line with other transplant populations.Finally,it is foreseeable that the future will be conditioned by the emerging variants of severe acute respiratory syndrome coronavirus 2 with increased transmissibility among LT recipients.
