BACKGROUND The average age of recipients and donors of liver transplantation(LT)is increasing.Although there has been a change in the indications for LT over the years,data regarding the trends and outcomes of LT in t...BACKGROUND The average age of recipients and donors of liver transplantation(LT)is increasing.Although 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 limited.AIM To assess the clinical characteristics,age-related trends,and outcomes of LT among the older population in the United States.METHODS We analyzed data from the United Network for Organ Sharing database between 1987-2019.The 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 States.During 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 groups.In 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 the time of LT,higher MELD score,presence of por展开更多
Due to the worldwide epidemic of obesity, nonalcoholic fatty liver disease(NAFLD) has become the most com-mon cause of elevated liver enzymes. NAFLD represents a spectrum of liver injury ranging from simple steato-sis...Due to the worldwide epidemic of obesity, nonalcoholic fatty liver disease(NAFLD) has become the most com-mon cause of elevated liver enzymes. NAFLD represents a spectrum of liver injury ranging from simple steato-sis to nonalcoholic steatohepatitis(NASH) which may progress to advanced fibrosis and cirrhosis. Individuals with NAFLD, especially those with metabolic syndrome, have higher overall mortality, cardiovascular mortality, and liver-related mortality compared with the general population. According to the population-based studies, NAFLD and NASH are more prevalent in males and in Hispanics. Both the gender and racial ethnic differences in NAFLD and NASH are likely attributed to interaction between environmental, behavioral, and genetic fac-tors. Using genome-wide association studies, several genetic variants have been identified to be associated with NAFLD/NASH. However, these variants account for only a small amount of variation in hepatic steatosis among ethnic groups and may serve as modifiers of the natural history of NAFLD. Alternatively, these variants may not be the causative variants but simply markers representing a larger body of genetic variations. In this article, we provide a concise review of the gender and racial differences in the prevalence of NAFLD and NASHin adults. We also discuss the possible mechanisms for these disparities.展开更多
文摘BACKGROUND The average age of recipients and donors of liver transplantation(LT)is increasing.Although 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 limited.AIM To assess the clinical characteristics,age-related trends,and outcomes of LT among the older population in the United States.METHODS We analyzed data from the United Network for Organ Sharing database between 1987-2019.The 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 States.During 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 groups.In 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 the time of LT,higher MELD score,presence of por
文摘Due to the worldwide epidemic of obesity, nonalcoholic fatty liver disease(NAFLD) has become the most com-mon cause of elevated liver enzymes. NAFLD represents a spectrum of liver injury ranging from simple steato-sis to nonalcoholic steatohepatitis(NASH) which may progress to advanced fibrosis and cirrhosis. Individuals with NAFLD, especially those with metabolic syndrome, have higher overall mortality, cardiovascular mortality, and liver-related mortality compared with the general population. According to the population-based studies, NAFLD and NASH are more prevalent in males and in Hispanics. Both the gender and racial ethnic differences in NAFLD and NASH are likely attributed to interaction between environmental, behavioral, and genetic fac-tors. Using genome-wide association studies, several genetic variants have been identified to be associated with NAFLD/NASH. However, these variants account for only a small amount of variation in hepatic steatosis among ethnic groups and may serve as modifiers of the natural history of NAFLD. Alternatively, these variants may not be the causative variants but simply markers representing a larger body of genetic variations. In this article, we provide a concise review of the gender and racial differences in the prevalence of NAFLD and NASHin adults. We also discuss the possible mechanisms for these disparities.
