Anderson Christopher D, Vachharajani Neeta, Doyle Majella, Lowell Jeffrey A, Wellen Jason R, Shenoy Surendra, Lisker-Melman Mauricio, Korenblat Kevin, Crippin Jeff, Chapman William C
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO, USA.
J Am Coll Surg. 2008 Dec;207(6):847-52. doi: 10.1016/j.jamcollsurg.2008.08.009. Epub 2008 Oct 2.
Individuals greater than 60 years old donate an important portion of the organs available for orthotopic liver transplantation (OLT), but use of donors in this age group remains controversial. We hypothesized that proper selection of donors older than age 60 would not disadvantage recipients in terms of patient and graft survival.
All OLTs performed at our center between January 1, 1990, and July 31, 2007, were divided into groups based on donor age: donors 60 years old or more and donors less than 60 years old. Recipients in each group were compared based on graft and patient survival at 1, 3, and 5 years, Model for End-Stage Liver Disease (MELD) scores, cold ischemic times, and era of transplant (before or after 2001).
There were 741 recipients who met inclusion criteria. Ninety-one patients received livers from donors 60 years old or older, and 650 patients had donors younger than 60 years old. Overall patient survival rates in the group using donors 60 or older were 86.8%, 72.6%, and 67.6% at 1, 3, and 5 years, respectively, and did not differ significantly from survival in the group receiving transplants from donors less than 60 (87.1%, 81.8%, and 75.5%; p=0.39). The 1-, 3-, and 5-year graft survivals in patients receiving transplants from donors 60 or older were 82.4%, 65%, and 62.5%, respectively, and were not significantly different from those in the group using donors younger than 60 (84%, 78.6%, and 72.3%, respectively; p=0.39). Neither patient survival nor graft survival in recipients of organs from donors 60 or older was affected by Model of End-Stage Liver Disease score. Recipients of older-donor livers had improved outcomes after 2001, which correlated with significant improvements in cold ischemic times.
Our data suggest that age alone does not adversely affect recipient outcomes. When properly selected, donors older than 60 represent an important and safe increase in the liver donor pool.
60岁以上的个体捐献了可用于原位肝移植（OLT）的重要部分器官，但该年龄组供体的使用仍存在争议。我们假设，对60岁以上供体进行适当选择，在患者和移植物存活方面不会对受者不利。
将1990年1月1日至2007年7月31日在我们中心进行的所有OLT，根据供体年龄分为两组：60岁及以上的供体和60岁以下的供体。比较每组受者在1年、3年和5年时的移植物和患者存活率、终末期肝病模型（MELD）评分、冷缺血时间以及移植时代（2001年之前或之后）。
有741名受者符合纳入标准。91名患者接受了60岁及以上供体的肝脏，650名患者的供体年龄小于60岁。使用60岁及以上供体的组中，患者1年、3年和5年的总体存活率分别为86.8%、72.6%和67.6%，与接受60岁以下供体移植的组的存活率（87.1%、81.8%和75.5%；p = 0.39）相比，差异无统计学意义。接受60岁及以上供体移植的患者1年、3年和5年的移植物存活率分别为82.4%、65%和62.5%，与使用60岁以下供体的组（分别为84%、78.6%和72.3%；p = 0.39）相比，差异无统计学意义。60岁及以上供体器官受者的患者存活率和移植物存活率均不受终末期肝病模型评分的影响。2001年后，老年供体肝脏受者的预后有所改善，这与冷缺血时间的显著改善相关。
我们的数据表明，仅年龄因素不会对受者预后产生不利影响。经过适当选择，60岁以上的供体可使肝脏供体库得到重要且安全的扩充。
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