Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis
BACKGROUND: There is increasing evidence for a heterogeneity of phenotypes in primary sclerosing cholangitis (PSC), but differences across the age spectrum in adults with PSC have not been well characterized.
AIMS: To characterize phenotypic variations and liver transplantation outcomes by age group in adults with PSC.
METHODS: The United Network for Organ Sharing database was used to identify waitlist registrations for primary liver transplantation in adults with PSC. Patients were split into three age groups: 18-39 (young), 40-59 (middle-aged), and ≥60 (older). Their clinical characteristics and outcomes on the waitlist and post-transplant were compared.
RESULTS: Overall, 8272 adults with PSC were listed for liver transplantation during the study period, of which 28.9% were young, 52.0% were middle-aged, and 19.1% were older. The young age group had the greatest male predominance (70.0 vs. 66.2 vs. 65.1%, p = 0.001), the highest proportion of black individuals (20.0 vs. 11.0 vs. 5.5%, p < 0.001), and the most patients listed with concomitant autoimmune hepatitis (2.2 vs. 1.0 vs. 0.8%, p < 0.001). Older patients experienced the greatest waitlist and post-transplant mortality. Graft survival was greatest in the middle-aged group. Young patients were most likely to experience acute rejection (31 vs. 22.8 vs. 18.0%, p < 0.001) and have graft failure due to chronic rejection or PSC recurrence (47.8 vs. 42.3 vs. 17.9%, p < 0.001).
CONCLUSIONS: Age-related differences exist among adults with PSC and are associated with outcomes pre- and post-transplant. Young patients may have a more robust immune-related phenotype that is associated with poorer graft survival. Future studies are needed to further investigate these findings.
| Errataetall: |
CommentIn: Dig Dis Sci. 2017 Nov;62(11):3210-3211. - PMID 28965148 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:62 |
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| Enthalten in: |
Digestive diseases and sciences - 62(2017), 11 vom: 01. Nov., Seite 3200-3209 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Henson, Jacqueline B [VerfasserIn] |
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| Links: |
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| Themen: |
Age factors |
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| Anmerkungen: |
Date Completed 06.11.2017 Date Revised 13.11.2018 published: Print-Electronic CommentIn: Dig Dis Sci. 2017 Nov;62(11):3210-3211. - PMID 28965148 Citation Status MEDLINE |
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| doi: |
10.1007/s10620-017-4559-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM270790233 |
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| 100 | 1 | |a Henson, Jacqueline B |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis |
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| 500 | |a Date Revised 13.11.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Dig Dis Sci. 2017 Nov;62(11):3210-3211. - PMID 28965148 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: There is increasing evidence for a heterogeneity of phenotypes in primary sclerosing cholangitis (PSC), but differences across the age spectrum in adults with PSC have not been well characterized | ||
| 520 | |a AIMS: To characterize phenotypic variations and liver transplantation outcomes by age group in adults with PSC | ||
| 520 | |a METHODS: The United Network for Organ Sharing database was used to identify waitlist registrations for primary liver transplantation in adults with PSC. Patients were split into three age groups: 18-39 (young), 40-59 (middle-aged), and ≥60 (older). Their clinical characteristics and outcomes on the waitlist and post-transplant were compared | ||
| 520 | |a RESULTS: Overall, 8272 adults with PSC were listed for liver transplantation during the study period, of which 28.9% were young, 52.0% were middle-aged, and 19.1% were older. The young age group had the greatest male predominance (70.0 vs. 66.2 vs. 65.1%, p = 0.001), the highest proportion of black individuals (20.0 vs. 11.0 vs. 5.5%, p < 0.001), and the most patients listed with concomitant autoimmune hepatitis (2.2 vs. 1.0 vs. 0.8%, p < 0.001). Older patients experienced the greatest waitlist and post-transplant mortality. Graft survival was greatest in the middle-aged group. Young patients were most likely to experience acute rejection (31 vs. 22.8 vs. 18.0%, p < 0.001) and have graft failure due to chronic rejection or PSC recurrence (47.8 vs. 42.3 vs. 17.9%, p < 0.001) | ||
| 520 | |a CONCLUSIONS: Age-related differences exist among adults with PSC and are associated with outcomes pre- and post-transplant. Young patients may have a more robust immune-related phenotype that is associated with poorer graft survival. Future studies are needed to further investigate these findings | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
| 650 | 4 | |a Age factors | |
| 650 | 4 | |a Liver transplantation | |
| 650 | 4 | |a Phenotype | |
| 650 | 4 | |a Sclerosing cholangitis | |
| 650 | 4 | |a Treatment outcome | |
| 700 | 1 | |a Patel, Yuval A |e verfasserin |4 aut | |
| 700 | 1 | |a Wilder, Julius M |e verfasserin |4 aut | |
| 700 | 1 | |a Zheng, Jiayin |e verfasserin |4 aut | |
| 700 | 1 | |a Chow, Shein-Chung |e verfasserin |4 aut | |
| 700 | 1 | |a King, Lindsay Y |e verfasserin |4 aut | |
| 700 | 1 | |a Muir, Andrew J |e verfasserin |4 aut | |
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