Doyle M B Majella, Anderson Christopher D, Vachharajani Neeta, Lowell Jeffrey A, Shenoy Surendra, Lisker-Melman Mauricio, Korenblat Kevin, Crippin Jeffrey S, Chapman William C
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Arch Surg. 2008 Jul;143(7):679-85; discussion 685. doi: 10.1001/archsurg.143.7.679.
Older donor grafts will provide suitable results of liver transplant, even in recipients with hepatitis C virus (HCV). Although HCV remains the leading indication for liver transplant in adults in the United States, it is associated with HCV recurrence, increased graft loss, and reduced survival. In addition, recent studies suggest that the use of older donors in recipients with HCV is associated with significantly worsened short- and long-term survival.
Prospective database analysis.
Washington University School of Medicine.
Between January 1, 1997, and June 30, 2006, a total of 579 liver transplants were performed. Ninety pediatric transplants were excluded. Of the remaining 489 adult patients (84.5%), 187 (38.2%) had HCV and 302 (61.8%) had other indications.
Patient and graft survival, recurrence of HCV, and need for and results of retransplant.
At 1, 3, and 5 years, overall patient survival was 88.1%, 78.3%, and 69.2%, respectively, and graft survival was 85.6%, 75.6%, and 65.6%, respectively, in patients with HCV. There was no significant difference in patient or graft survival between patients with and those without HCV. Recurrent HCV with clinically significant disease was 20% at 1 year and 62% at 10 years. Seventy-two patients received transplants from donors 60 years or older (24 of 187 [12.8%] with HCV and 48 of 302 [15.9%] without HCV). No difference was demonstrated in short- or medium-term patient or graft survival in recipients of grafts from older donors.
The increasing use of marginal donors, including carefully selected older donors, does not seem to adversely affect short- or medium-term results and may be a source of additional organs for expanding liver transplant waiting lists.
即便对于丙型肝炎病毒（HCV）感染者，老年供体肝脏移植也能取得合适的效果。在美国，HCV仍是成人肝移植的主要指征，但其与HCV复发、移植肝失功增加及生存率降低相关。此外，近期研究表明，HCV感染者使用老年供体与短期及长期生存率显著恶化相关。
前瞻性数据库分析。
华盛顿大学医学院。
1997年1月1日至2006年6月30日期间，共进行了579例肝移植手术。排除90例儿童移植患者。其余489例成年患者（84.5%）中，187例（38.2%）感染HCV，302例（61.8%）有其他指征。
患者及移植肝生存率、HCV复发情况以及再次移植的需求和结果。
HCV感染患者1年、3年和5年的总体患者生存率分别为88.1%、78.3%和69.2%，移植肝生存率分别为85.6%、75.6%和65.6%。HCV感染患者与未感染患者的患者或移植肝生存率无显著差异。1年时临床显著疾病的HCV复发率为20%，10年时为62%。72例患者接受了60岁及以上供体的肝脏移植（187例HCV感染者中有24例[12.8%]，302例未感染HCV者中有48例[15.9%]）。老年供体肝脏移植受者的短期或中期患者或移植肝生存率无差异。
包括精心挑选的老年供体在内的边缘供体的使用增加，似乎并未对短期或中期结果产生不利影响，并且可能成为增加肝移植等待名单器官来源的途径。
