Alamo J-M, Olivares C, Jiménez G, Bernal C, Marín L M, Tinoco J, Suárez G, Serrano J, Padillo J, Gómez M-Á
Liver Transplant Unit, Virgen del Rocío Hospital, Seville, Spain.
Transplant Proc. 2013;45(10):3633-6. doi: 10.1016/j.transproceed.2013.10.031.
The use of grafts from donors older than 70 years of age is increasing due to the decrease in the number of donors and the increase in waiting list patients.
We undertook a univariate and multivariate analysis of 980 adult recipients of whole liver grafts, 129 of them from donors aged 70 years or older.
No differences were found in patient survival compared with recipients of younger grafts. There were no higher rates of rejection, vascular or biliary complications, postoperative bleeding, or infections, but older grafts were associated with graft dysfunction (P = .01) and a higher frequency of postoperative refractory ascites (P = .007), but without a greater need for retransplantation. As graft-associated factors, the joint presence in the donor of diabetes (P = .00; confidence interval [CI] = 0.04-0.117), hypertension (P = .00; CI = 0.22-0.39), and weight of more than 90 kg (P = .031; CI = 0.05-0.104) were suggestive of poor prognostic factors in recipient survival. Survival in hepatitis C virus (HCV) recipients or recipients aged older than 60 years was worse with donors aged older than 70 years, although not significantly so. With grafts from donors aged older than 80 years (n = 15), although patient survival rate was good (70% at 10 years), there was a higher rate of retransplantation (20%) and the early mortality rate was 13.3%.
Use of grafts from donors aged older than 70 years is safe, with similar survival to patients with younger grafts. The appearance of initial dysfunction with prolonged ascites may be due to a delay in reaching a correct functionality, but was not associated with increased mortality, complications, or need for retransplantation. It should also be avoided in recipients older than 60 years or with HCV. Grafts older than 80 years were associated with a good long-term patient survival but at the expense of a higher rate of retransplantation. However, it helps to reduce the time on the waiting list and, thus, mortality. We noted decreased survival associated with donor hypertension, diabetes, and obesity, so these donors should be selected more rigorously.
由于供体数量减少和等待名单上患者数量增加，70岁以上供体移植物的使用正在增加。
我们对980例接受全肝移植的成年受者进行了单因素和多因素分析，其中129例来自70岁及以上的供体。
与年轻移植物受者相比，患者生存率无差异。排斥反应、血管或胆道并发症、术后出血或感染的发生率没有更高，但老年移植物与移植物功能障碍（P = 0.01）和术后难治性腹水的发生率较高（P = 0.007）相关，但再次移植的需求并未增加。作为与移植物相关的因素，供体同时存在糖尿病（P = 0.00；置信区间[CI] = 0.04 - 0.117）、高血压（P = 0.00；CI = 0.
