Selzner Markus, Kashfi Arash, Selzner Nazia, McCluskey Stuart, Greig Paul D, Cattral Mark S, Levy Gary A, Lilly Les, Renner Eberhard L, Therapondos George, Adcock Lesley E, Grant David R, McGilvray Ian D
Division of Multiorgan Transplantation, Department of General Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
Liver Transpl. 2009 Oct;15(10):1288-95. doi: 10.1002/lt.21828.
We studied the role of donor and recipient age in transplantation/ischemia-reperfusion injury (TIRI) and short- and long-term graft and patient survival. Eight hundred twenty-two patients underwent deceased donor liver transplantation, with 197 donors being > or = 60 years old. We evaluated markers of reperfusion injury, graft function, and clinical outcomes as well as short- and long-term graft and patient survival. Increased donor age was associated with more severe TIRI and decreased 3- and 5-year graft survival (73% versus 85% and 72% versus 81%, P < 0.001) and patient survival (77% versus 88% and 77% versus 82%, P < 0.003). Hepatitis C virus (HCV) infection and recipient age were the only independent risk factors for graft and patient survival in patients receiving an older graft. In the HCV(+) cohort (297 patients), patients > or = 50 years old who were transplanted with an older graft versus a younger graft had significantly decreased 3- and 5-year graft survival (68% versus 83% and 64% versus 83%, P < 0.009). In contrast, HCV(+) patients < 50 years old had similar 3- and 5-year graft survival if transplanted with either a young graft or an old graft (81% versus 82% and 81% versus 82%, P = 0.9). In conclusion, recipient age and HCV status affect the graft and patient survival of older livers. Combining older grafts with older recipients should be avoided, particularly in HCV(+) patients, whereas the effects of donor age can be minimized in younger recipients.
我们研究了供体和受体年龄在移植/缺血再灌注损伤（TIRI）以及短期和长期移植物与患者生存中的作用。822例患者接受了尸体供肝移植，其中197例供体年龄≥60岁。我们评估了再灌注损伤标志物、移植物功能、临床结局以及短期和长期移植物与患者生存情况。供体年龄增加与更严重的TIRI相关，且3年和5年移植物生存率降低（分别为73%对85%和72%对81%，P<0.001）以及患者生存率降低（分别为77%对88%和77%对82%，P<0.003）。丙型肝炎病毒（HCV）感染和受体年龄是接受老年供肝患者移植物和患者生存的仅有的独立危险因素。在HCV阳性队列（297例患者）中，年龄≥50岁且接受老年供肝而非年轻供肝移植的患者，其3年和5年移植物生存率显著降低（分别为68%对83%和64%对83%，P<0.009）。相比之下，年龄<50岁的HCV阳性患者，无论接受年轻供肝还是老年供肝移植，其3年和5年移植物生存率相似（分别为81%对82%和81%对82%，P = 0.9）。总之，受体年龄和HCV状态影响老年供肝的移植物和患者生存。应避免将老年供肝与老年受体联合，尤其是在HCV阳性患者中，而在年轻受体中可将供体年龄的影响降至最低。
