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Simultaneous Liver Kidney Transplant in Elderly Patients With Chronic Kidney Disease: Is There an Appropriate Upper Age Cutoff?

Abstract：

BACKGROUND:The aging of liver transplant (LT) recipients, the weighting of the model for end-stage liver disease score, and the increased prevalence of nonalcoholic steatohepatitis has led to an increased number of older LT recipients with pre-LT chronic kidney disease (CKD). There are limited data on the impact of increased recipient age on post-simultaneous liver-kidney (SLK) transplant outcomes among patients with CKD, leading some centers to employ subjective age cutoffs for potential SLK recipients. METHODS:We evaluated United Network for Organ Sharing data of adult SLK recipients from February 27, 2002, to December 31, 2018, restricted to recipients with ≥90 days of waiting time and CKD (estimated glomerular filtration rate persistently <60 mL/min/1.73 m2 for ≥90 d using the modification of diet in renal disease-4 equation). We fit mixed-effects Cox regression models (center as random effect) to evaluate the association of recipient age and patient survival. RESULTS:Among 3146 SLK recipients with CKD, nearly two-thirds were 50-64 years of age, while 465 (14.8%) and 93 (3.0%) were 65-69 years and ≥70 years, respectively. Compared with nondiabetic SLK recipients aged 50-59 years, SLK recipients ≥70 years of age without diabetes (hazard ratio, 1.97; 95% CI, 1.20-3.23; P = 0.007) and with diabetes (hazard ratio, 1.90; 95% CI, 1.16-3.09; P = 0.01) had higher mortality compared with the reference group. In absolute terms, SLK recipients ≥70 years of age had 25% lower patient survival at 5 years compared to recipients aged 40-49 years. CONCLUSIONS:Although careful selection is required of any SLK recipient, especially those with increased comorbidities, there are no objective data to justify a specific age cutoff <70 years among potential SLK recipients with CKD.

journal_name

Transplantation

journal_title

Transplantation

authors

Goldberg DS,Vianna RM,Martin EF,Martin P,Arosemena Benitez LR,O'Brien CB,Bhamidimarri KR

doi

10.1097/TP.0000000000003147

subject

Has Abstract

pub_date

2020-12-01 00:00:00

pages

2538-2546

issue

eissn

0041-1337

issn

1534-6080

pii

00007890-202012000-00018

journal_volume

104

pub_type

杂志文章

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Simultaneous Liver Kidney Transplant in Elderly Patients With Chronic Kidney Disease: Is There an Appropriate Upper Age Cutoff?