Santori G, Andorno E, Morelli N, Bottino G, Mondello R, Gianelli Castiglione A, Valente U
Department of Transplantation, San Martino University Hospital, Genoa, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2576-81. doi: 10.1016/j.transproceed.2005.06.074.
The increase in the number of patients awaiting liver transplantation (OLT) has forced the use of cadaveric donors (CD) with suboptimal characteristics. Of these, donor age is perhaps the most investigated parameter. Although excellent outcomes were observed for OLT using CD aged over 60 years, the European Liver Transplant Registry (ELTR) Group found an increased risk by using CD of more than 55 years. The Italian National Transplant Center has recently assumed that CD age more than 60 years is a potential risk factor for OLT. In this study, a single-center analysis was performed by stratifying CD by three age cut-offs (< or =55 or >55, < or =60 or >60, and < or =65 or >65 years) to evaluate effects on OLT outcome. Although no significant difference in 6-month and 1-year patient or graft survival occurred after stratification for each donor age cut-off, a better survival was observed with OLT performed using livers procured from CD >55 years. A significant increase in cold ischemia time (CIT) was observed among OLT performed with grafts procured from CD < or =55 and < or =65 years (P = .007), and there was an inverse correlation between overall CIT and donor age (R = -0.300; P = .0022). However, no impact on 1-year patient survival was observed by introducing CIT in univariate logistic regression models as well as donor age, recipient age, donor/recipient age ratio, donor/recipient sex mismatch, ELTR diagnostic categories, and UNOS status. The results of this study suggest the suitability of CD of more than 55 years for OLT and the need to further investigate the cut-off value for CIT-related risk.
等待肝移植（OLT）的患者数量不断增加，这迫使人们开始使用特征欠佳的尸体供体（CD）。其中，供体年龄可能是研究最多的参数。尽管使用60岁以上尸体供体进行肝移植取得了良好的效果，但欧洲肝脏移植登记处（ELTR）研究组发现，使用55岁以上的尸体供体进行肝移植会增加风险。意大利国家移植中心最近认定，60岁以上的尸体供体是肝移植的一个潜在风险因素。在本研究中，我们进行了一项单中心分析，将尸体供体按三个年龄界限（≤55岁或＞55岁、≤60岁或＞60岁、≤65岁或＞65岁）进行分层，以评估其对肝移植结果的影响。尽管在对每个供体年龄界限进行分层后，6个月和1年时的患者或移植物存活率没有显著差异，但使用55岁以上尸体供体肝脏进行的肝移植显示出更好的存活率。在使用≤55岁和≤65岁尸体供体移植物进行的肝移植中，冷缺血时间（CIT）显著增加（P = 0.007），并且总体冷缺血时间与供体年龄呈负相关（R = -0.300；P = 0.0022）。然而，在单因素逻辑回归模型中引入冷缺血时间以及供体年龄、受体年龄、供体/受体年龄比、供体/受体性别不匹配、ELTR诊断类别和UNOS状态后，未观察到对1年患者存活率有影响。本研究结果表明，55岁以上的尸体供体适合进行肝移植，并且有必要进一步研究与冷缺血时间相关风险的临界值。
