Jiménez Romero C, Moreno González E, Colina Ruíz F, Palma Carazo F, Loinaz Segurola C, Rodríguez González F, González Pinto I, García García I, Rodríguez Romano D, Moreno Sanz C
Department of General and Digestive Surgery and Organ Transplantation, Hospital Universitario Doce de Octubre, Madrid, Spain.
Transplantation. 1999 Aug 27;68(4):572-5. doi: 10.1097/00007890-199908270-00021.
The increasing number of recipients on the waiting list for orthotopic liver transplantation (OLT) and the scarcity of donors contribute to recipient pretransplantation mortality. One important measure to increase the donor liver pool would be to accept the previously discarded donors who are more than 80 years old.
From November 1996 to May 1998, four liver grafts from octogenarian donors (89, 87, 82, and 85 years old, respectively) were used for OLT. Pretransplantation donor and recipient characteristics and the evolution of recipients after OLT were analyzed.
The donors did not present cardiac arrest or hypotension, and only low doses of vasopressors were required in three of them. Intensive care unit stay of the donors was from 12 to 24 hr. Cold ischemia time was from 4 hr to 8 hr 40 min. Mild microsteatosis was present in three donors and associated macrosteatosis of < 10% in one of these. Macroscopic appearance and consistency were normal in all four grafts. Posttransplantation evolution and follow-up were uneventful. Three recipients were alive and well at 24, 16, and 7 months; the second of these died at 16 months of recurrent viral C cirrhosis after a first OLT.
The liver donor pool can be increased if liver grafts are accepted without an age limit but in good condition (hemodynamic stability, short intensive care unit stay, good liver function, soft consistency, cold ischemia time <9 hr, and no severe steatosis). Octogenarian donors should be individually assessed in the absence of these ideal conditions.
原位肝移植（OLT）等待名单上的受者数量不断增加，而供体稀缺导致受者移植前死亡率上升。增加供肝库的一项重要措施是接受先前被弃用的80岁以上供体。
1996年11月至1998年5月，4例来自八旬供体（分别为89岁、87岁、82岁和85岁）的肝移植物用于OLT。分析了移植前供体和受者的特征以及OLT后受者的病情演变。
供体未出现心脏骤停或低血压，其中3例仅需低剂量血管升压药。供体在重症监护病房的停留时间为12至24小时。冷缺血时间为4小时至8小时40分钟。3例供体存在轻度微脂肪变性，其中1例伴有<10%的大脂肪变性。所有4例移植物的大体外观和质地均正常。移植后病情演变及随访均顺利。3例受者在24个月、16个月和7个月时存活且情况良好；其中第二例在首次OLT后16个月死于复发性丙型病毒性肝硬化。
如果不设年龄限制但肝脏状况良好（血流动力学稳定、在重症监护病房停留时间短、肝功能良好、质地柔软、冷缺血时间<9小时且无严重脂肪变性）就接受肝移植物，那么供肝库可以增加。在缺乏这些理想条件的情况下，应单独评估八旬供体。
