Simultaneous liver and kidney transplantation in elderly patients: Outcomes and validation of a clinical risk score for patient selection
Título del documento: Simultaneous liver and kidney transplantation in elderly patients: Outcomes and validation of a clinical risk score for patient selection
Revista: Annals of hepatology
Base de datos: PERIÓDICA
Número de sistema: 000406022
ISSN: 1665-2681
Autors: 1
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Institucions: 1Mayo Clinic, Department of Transplant, Jacksonville, Florida. Estados Unidos de América
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Període: Nov-Dic
Volum: 15
Número: 6
Paginació: 870-880
País: México
Idioma: Inglés
Tipo de documento: Artículo
Enfoque: Analítico, descriptivo
Resumen en inglés Many transplant programs have expanded eligibility to include patients previously ineligible because of advanced age. Outcomes of simultaneous liver-kidney transplantation (SLK) in recipients with advanced age are not known. Material Material and methods. and methods. Data and methods. from patients undergoing transplantation between 2002 and 2015 were obtained from the UNOS Standard Analysis and Research file. Results. Results. SLK Results. recipients aged ≥ 65 years (N = 677), SLK recipients aged < 65 years (N = 4517), and recipients of liver transplant alone(LTA) aged ≥ 65 years(N = 8495) were compared. Recipient characteristics were similar between the SLK groups. Similar patient and graft survival were observed in SLK recipients aged ≥ 65 years compared to SLK recipients aged < 65 years and LTA recipients aged ≥ 65 years. Importantly, in a subgroup analysis, superior survival was seen in the SLK group aged ≥ 65 years compared to LTA recipients aged ≥ 65 years who underwent dialysis in the week prior to transplantation (p < 0.001). A prediction model of patient survival was developed for the SLK group aged ≥ 65 years with predictors including: age ≥ 70 years (3 points), calculated MELD score (-1 to 2 points), and recipient ventilator status at the time of SLK (4 points). The risk score predicted patient survival, with a significantly inferior survival seen in patients with a score ≥ 4 (p < 0.001). Conclusions. Conclusions. Age Conclusions. should not be used as a contraindication for SLK transplantation. The validated scoring system provides a guide for patient selection and can be used when evaluating elderly patients for SLK transplantation listing
Disciplines Medicina
Paraules clau: Cirugía,
Gastroenterología,
Geriatría,
Nefrología,
Trasplante simultáneo,
Riñones,
Hígado,
Ancianos,
Riesgo clínico,
Selección de pacientes
Keyword: Medicine,
Gastroenterology,
Geriatrics,
Nephrology,
Surgery,
Simultenous transplantation,
Kidneys,
Liver,
Aged,
Clinical risk,
Patients selection
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