Levy M F, Somasundar P S, Jennings L W, Jung G J, Molmenti E P, Fasola C G, Goldstein R M, Gonwa T A, Klintmalm G B
Baylor University Medical Center, Transplantation Services, Dallas, Texas 75246, USA.
Ann Surg. 2001 Jan;233(1):107-13. doi: 10.1097/00000658-200101000-00016.
To determine whether liver transplantation is judicious in recipients older than 60 years of age.
The prevailing opinion among the transplant community remains that elderly recipients of liver allografts fare as well as their younger counterparts, but our results have in some cases been disappointing. This study was undertaken to review the results of liver transplants in the elderly in a large single-center setting. A secondary goal was to define, if possible, factors that could help the clinician in the prudent allocation of the donor liver.
A retrospective review of a prospectively maintained single-institution database of 1,446 consecutive liver transplant recipients was conducted. The 241 elderly patients (older than 60 years) were compared with their younger counterparts by preoperative laboratory values, illness severity, nutritional status, and donor age. Survival data were stratified and logistic regression analyses were conducted.
Elderly patients with better-preserved hepatic synthetic function or with lower pretransplant serum bilirubin levels fared as well as younger patients. Elderly patients who had poor hepatic synthetic function or high bilirubin levels or who were admitted to the hospital had much lower survival rates than the sicker younger patients or the less-ill older patients. Recipient age 60 years or older, pretransplant hospital admission, and high bilirubin level were independent risk factors for poorer outcome.
Low-risk elderly patients fare as well as younger patients after liver transplantation. However, unless results can be improved, high-risk patients older than 60 years should probably not undergo liver transplantation.
确定肝移植对于60岁以上受者是否明智。
移植界的普遍观点仍然是，肝移植老年受者的情况与年轻受者一样好，但我们的结果在某些情况下令人失望。本研究旨在回顾在大型单中心环境中进行的老年肝移植结果。第二个目标是尽可能确定有助于临床医生谨慎分配供肝的因素。
对前瞻性维护的单机构连续1446例肝移植受者数据库进行回顾性研究。将241例老年患者（60岁以上）与年轻受者在术前实验室检查值、疾病严重程度、营养状况和供体年龄方面进行比较。对生存数据进行分层并进行逻辑回归分析。
肝合成功能保存较好或移植前血清胆红素水平较低的老年患者与年轻患者情况相同。肝合成功能差、胆红素水平高或入院的老年患者的生存率远低于病情较重的年轻患者或病情较轻的老年患者。60岁及以上的受者年龄、移植前入院和高胆红素水平是预后较差的独立危险因素。
低风险老年患者肝移植后的情况与年轻患者相同。然而，除非结果能够改善，60岁以上的高风险患者可能不应接受肝移植。
