Abstract：
Despite the controversial results of liver transplantation (LT) in elderly recipients, the proportion of patients continues to increase. This study investigated the outcome of LT in elderly patients (≥ 65 years) in an Italian, multicenter cohort. Between January 2014 and December 2019, 693 eligible patients were transplanted, and two groups were compared: recipients ≥ 65 years (n = 174, 25.1%) versus 50-59 years (n = 519, 74.9%). Confounders were balanced using a stabilized inverse probability therapy weighting (IPTW). Elderly patients showed more frequent early allograft dysfunction (23.9 versus 16.8%, p = 0.04). Control patients had longer posttransplant hospital stays (median: 14 versus 13 days; p = 0.02), while no difference was observed for posttransplant complications (p = 0.20). At multivariable analysis, recipient age ≥ 65 years was an independent risk factor for patient death (HR 1.76; p = 0.002) and graft loss (HR 1.63; p = 0.005). The 3-month, 1-year, and 5-year patient survival rates were 82.6, 79.8, and 66.4% versus 91.1, 88.5, and 82.0% in the elderly and control group, respectively (log-rank p = 0.001). The 3-month, 1-year, and 5-year graft survival rates were 81.5, 78.7, and 66.0% versus 90.2, 87.2, and 79.9% in the elderly and control group, respectively (log-rank p = 0.003). Elderly patients with CIT > 420 min showed 3-month, 1-year, and 5-year patient survival rates of 75.7%, 72.8%, and 58.5% versus 90.4%, 86.5%, and 79.4% for controls (log-rank p = 0.001). LT in elderly (≥ 65 years) recipients provides favorable results, but inferior to those achieved in younger patients (50-59), especially when CIT > 7 h. Containment of cold ischemia time seems pivotal for favorable outcomes in this class of patients.
摘要：
尽管有争议的结果肝移植（LT）在老年受体，患者比例继续增加。这项研究调查了意大利老年患者（≥65岁）的LT结果，多中心队列。2014年1月至2019年12月，693名符合条件的患者接受了移植，并对两组进行了比较:≥65岁(n=174,25.1%)和50-59岁(n=519,74.9%)的受者.使用稳定的逆概率治疗加权(IPTW)平衡混杂因素。老年患者表现出更频繁的早期同种异体移植功能障碍（23.9对16.8％，p=0.04)。对照组患者移植后住院时间更长（中位数：14天与13天；p=0.02），而移植后并发症没有观察到差异（p=0.20）。在多变量分析中，受者年龄≥65岁是患者死亡(HR1.76;p=0.002)和移植物丢失(HR1.63;p=0.005)的独立危险因素.三个月,1年,老年组和对照组的5年生存率分别为82.6、79.8和66.4%，与91.1、88.5和82.0%相比，分别(对数秩p=0.001)。三个月,1年,老年人和对照组的5年移植物存活率分别为81.5、78.7和66.0％，而老年人和对照组为90.2、87.2和79.9％，分别(对数秩p=0.003)。CIT>420分钟的老年患者显示3个月，1年,患者5年生存率为75.7%，72.8%,和58.5%对90.4%，86.5%,对照组为79.4%（对数秩p=0.001）。老年(≥65岁)接受者的LT提供了良好的结果，但不如年轻患者（50-59），尤其是当CIT>7小时时。在这类患者中，控制冷缺血时间对于良好的预后至关重要。
