PO.CL09.02 · 临床研究
病毒性肝炎悖论：老年HCC移植患者预后更佳
Viral hepatitis paradox: Better outcomes in geriatric HCC transplant patients
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
肝细胞癌（HCC）在需要肝移植的老年患者中导致显著死亡率。传统观点认为病毒性肝炎会恶化移植预后。我们假设病毒状态会显著影响生存结局，且HBV/HCV合并感染与代谢合并症之间可能存在交互作用。我们分析了来自United Network for Organ Sharing数据库的7890例接受HCC肝移植的老年患者（≥65岁），按乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）状态进行分层。与预期相反，HCV阳性患者表现出显著更优的5年生存率，HBV+/HCV+患者达到33.9%的生存率，而HBV-/HCV-患者为27.3%。HBV+/HCV+患者的平均生存时间比HBV-/HCV-患者长182天（1361 vs 1179天，p<0.001）。糖尿病与结局呈现复杂关联，合并感染的糖尿病患者生存尤其差（6.2% vs 非糖尿病患者的45.0%）。年龄在所有组中均与生存呈负相关，在合并感染患者中相对较高（r=-0.160）。这些发现挑战了当前的移植评估范式，提示在老年人群中病毒状态的复杂性需要重新评估。我们的结果表明，HCV不应自动将老年患者排除在移植考虑之外，而糖尿病需要谨慎管理，尤其是在合并感染的患者中。
查看英文原文 English abstract
Hepatocellular carcinoma (HCC) causes significant mortality among elderly patients requiring liver transplantation. Traditional assumptions suggest viral hepatitis worsens transplant outcomes. We hypothesized that viral status would significantly influence survival outcomes, with potential interactions between HBV/HCV co-infection and metabolic comorbidities. We analyzed 7,890 geriatric patients (≥65 years) from the United Network for Organ Sharing database who received liver transplants for HCC, stratifying them by hepatitis B virus (HBV) and hepatitis C virus (HCV) status. Contrary to expectations, HCV-positive patients demonstrated significantly superior 5-year survival rates, with HBV+/HCV+ patients achieving 33.9% survival versus 27.3% for HBV-/HCV- patients. Mean survival time was 182 days longer for HBV+/HCV+ patients compared to HBV-/HCV- patients (1,361 vs. 1,179 days, p<0.001). Diabetes mellitus showed complex associations with outcomes, with particularly poor survival in coinfected diabetic patients (6.2% vs. 45.0% for non-diabetics). Age showed negative correlations with survival in all groups, relatively high in co-infected patients (r=-0.160). These findings challenge current transplant evaluation paradigms, suggesting viral status complexity requires reassessment in geriatric populations. Our results indicate that HCV should not automatically exclude elderly patients from transplant consideration, while diabetes requires careful management, especially in co-infected patients.
利益披露 Disclosure
E. Kim, None..
S. Park, None..
A. Choi, None.