丙型肝炎病毒阳性（HCV(+)）供体与非丙型肝炎病毒受体的老年供体：肝移植后的患者生存率

Elderly donors for HCV(+) versus non-HCV recipients: patient survival following liver transplantation.

作者信息

Boin I F S F, Ataide E C, Leonardi M I, Stucchi R, Sevá-Pereira T, Pereira I W, Cardoso A R, Caruy C A, Luzo A, Leonardi L S

机构信息

Unit of Liver Transplantation, Unicamp, São Paulo, Brazil.

出版信息

Transplant Proc. 2008 Apr;40(3):792-6. doi: 10.1016/j.transproceed.2008.02.069.

DOI:10.1016/j.transproceed.2008.02.069

PMID:18455019

Abstract

INTRODUCTION

Chronic liver failure due to hepatitis C virus (HCV)-related cirrhosis is the leading indication for liver transplantation. Inferior long-term results have been reported for liver transplantation in HCV(+) patients, especially when marginal donor livers are utilized.

AIM

The aim of this study was to analyze retrospectively the outcome of liver transplantation patients from elderly donors in the case of HCV(+) versus non-HCV recipients.

METHODS

Among 330 liver transplantations performed from January 1994 to December 2006, we selected 244 excluding acute hepatic failure, children, and retransplants. Among these patients we analyzed 232 subjects who underwent the piggyback technique. Donor risk index (DRI) as described by Feng et al was applied using 1.7 as a cutoff value. We used Kaplan-Meier survival and Cox hazard regression analyses. We studied 14 donor variables using descriptive statistical tests.

RESULTS

There were 148 (63.8%) HCV(+) recipients and 84 (36.2%) non-HCV liver transplant recipients. Among HCV(+) recipients, 130/148 (87.8%) patients received livers, from donors less than 50 years old, and 18/148 (12.2%), over 50 years. The descriptive statistics of patient categorical variables are shown in Table 1, and continuous variables in Table 2. The cumulative proportional survival curves are shown in Figs 1 and 2. Mortality predictive factors in HCV(+) liver transplant recipients with donor age > 50 years old as determined by Cox hazard regression showed that death risk was increased with hazard ratios for warm ischemia = 1.01 (P = .001); for red blood cell intraoperative requirements = 2.63 (P = .003); for Child-Turcotte-Pugh classification points = 2.25 (P = .04), and for DRI > 1.7 = 2.19 (P = .03). In conclusion, advancing donor age, as well as the use of nonideal donors, intraoperative bleeding, and prolonged warm ischemia, had an adverse influence on patient survival for HCV(+) recipients.

摘要

引言

丙型肝炎病毒（HCV）相关肝硬化所致的慢性肝衰竭是肝移植的主要适应证。据报道，HCV阳性患者肝移植的长期效果较差，尤其是在使用边缘供肝时。

目的

本研究的目的是回顾性分析老年供肝肝移植患者中HCV阳性与非HCV受体的结局。

方法

在1994年1月至2006年12月进行的330例肝移植中，我们排除急性肝衰竭、儿童和再次移植患者后选择了244例。在这些患者中，我们分析了232例行背驮式技术的受试者。采用Feng等人描述的供体风险指数（DRI），以1.7作为临界值。我们使用了Kaplan-Meier生存分析和Cox风险回归分析。我们使用描述性统计检验研究了14个供体变量。

结果

有148例（63.8%）HCV阳性受体和84例（36.2%）非HCV肝移植受体。在HCV阳性受体中，130/148例（87.8%）患者接受了年龄小于50岁供体的肝脏，18/148例（12.2%）接受了年龄大于50岁供体的肝脏。患者分类变量的描述性统计见表1，连续变量见表2。累积比例生存曲线见图1和图2。Cox风险回归确定的供体年龄>50岁的HCV阳性肝移植受体的死亡预测因素显示，热缺血的风险比=1.01时死亡风险增加（P = .001）；术中红细胞需求量的风险比=2.63时（P = .003）；Child-Turcotte-Pugh分级点数的风险比=2.25时（P = .04），DRI>1.7的风险比=2.19时（P = .03）。总之，供体年龄增加以及使用非理想供体、术中出血和热缺血时间延长对HCV阳性受体的患者生存有不利影响。