从选定的老年供体获得的肝移植物没有明显更多的缺血再灌注损伤。
Liver grafts from selected older donors do not have significantly more ischaemia reperfusion injury.
机构信息
Department of Surgery, Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
出版信息
HPB (Oxford). 2011 Mar;13(3):212-20. doi: 10.1111/j.1477-2574.2010.00275.x.
BACKGROUND
There is a general concern that aged organs are more susceptible to ischaemia. In the light of recent proposals to change the liver allocation system by expanding regional sharing, it is feared that increased cold ischaemia time of grafts from older donors may reduce graft survival. The aim of this study was to correlate donor age and the patterns of ischaemia reperfusion injury and synthetic function early after liver transplantation.
METHODS
We performed a retrospective study of first transplants using a single-centre electronic database. Patterns of liver injury (based on transaminases and post-reperfusion biopsy), synthetic function (international normalized ratio [INR]), and graft and patient survival in recipients receiving liver grafts from donors aged ≥ 65 years (group 1, n= 50) were compared with equivalent patterns in a matched cohort of recipients transplanted with grafts from donors aged <65 years (group 2, n= 50).
RESULTS
There was no significant difference in transaminase levels from day 0 to day 6 after transplantation. When groups 1 and 2 were subdivided into two subgroups based on the duration of graft cold ischaemia time (<8 h and ≥ 8 h), there was no statistical difference in transaminase levels during the first 7 days. There were two cases (4%) of primary non-function in group 1 and one (2%) in group 2. Initial poor function did not differ significantly between the groups (26% vs. 24%; P= 0.81). In addition, there was no difference in histological changes in post-reperfusion biopsies (21% vs. 34%; P= 0.078) and rate of acute rejection episodes in the first year (30% vs. 32%; P= 0.99). There was no significant difference between groups 1 and 2 in 1-year patient and graft survivals (78% vs. 90% [P= 0.17]; 88% vs. 94% [P= 0.48], respectively).
CONCLUSIONS
Judiciously selected livers from aged donors are not associated with major increased susceptibility to ischaemia reperfusion injury.
背景
人们普遍担心衰老的器官更容易受到缺血的影响。鉴于最近提出通过扩大区域共享来改变肝脏分配系统的建议，人们担心来自年龄较大供体的移植物的冷缺血时间增加可能会降低移植物的存活率。本研究的目的是探讨供体年龄与肝移植后早期缺血再灌注损伤和合成功能的关系。
方法
我们使用单中心电子数据库对首次移植进行了回顾性研究。根据转氨酶和再灌注后活检，比较了年龄≥ 65 岁的供体（第 1 组，n=50）和年龄<65 岁的供体（第 2 组，n=50）的肝损伤模式、合成功能（国际标准化比值[INR]）以及受体的移植物和患者存活率。
结果
术后 0 至 6 天，转氨酶水平无显著差异。当将第 1 组和第 2 组根据移植物冷缺血时间的长短（<8 小时和≥8 小时）进一步分为两个亚组时，前 7 天的转氨酶水平无统计学差异。第 1 组有 2 例（4%）发生原发性无功能，第 2 组有 1 例（2%）。两组之间初始功能不良的差异无统计学意义（26%比 24%；P=0.81）。此外，再灌注活检的组织学变化（21%比 34%；P=0.078）和第一年急性排斥反应的发生率（30%比 32%；P=0.99）无差异。第 1 组和第 2 组在 1 年患者和移植物存活率方面无显著差异（78%比 90%[P=0.17]；88%比 94%[P=0.48]）。
结论
从年龄较大的供体中谨慎选择的肝脏与缺血再灌注损伤的易感性增加无关。
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