Franco C C, Martínez J M A, Bellido C B, Artacho G S, Gómez L M M, Diez-Canedo J S, Aunión C D, Ruiz F J P, Bravo M A G
Liver Transplant Unit, Virgen del Rocío University Hospital, Seville, Spain.
Transplant Proc. 2013;45(10):3647-9. doi: 10.1016/j.transproceed.2013.10.024.
The progressive increase in the number of liver transplantation candidates has brought with it a consequent increase in waiting list mortality, making it necessary to revise donor selection criteria and to analyze the factors that optimize outcomes. This retrospective observational study of 1802 liver transplantations performed in Andalusia between 2000 and 2010 analyzes the outcomes from donors aged 70 years or older (n = 211) in terms of survival rates of the graft and the recipient, the type of transplant, donor age, and DMELD (Donor-Model for End-Stage Liver Disease) score. The most frequent reasons for transplantation were alcoholic cirrhosis (45.5%), hepatitis C cirrhosis (20.4%), and liver cancer (11.8%). The overall survival rate at 5 years was 67%; with a significant decrease in survival rates for recipients with a DMELD greater than 1400 (44%). In the 70-year-old-plus donor group, the overall patient and graft survival rates were 57% and 52%, respectively. The re-transplantation rate increased proportionately with donor age: 5.9% between 70 and 74 years, 9.5% from 75 to 79 years, and 17.6% from 80 to 84 years. In the alcoholic cirrhosis recipient sub-group, the overall survival rate at 5 years was 69% (P < .05) compared to 34% in hepatitis C patients (P < .05). The widening of the donor age selection criteria is therefore a safe option, provided that a DMELD score less than 1400 is obtained. Although re-transplantation rates increase progressively with donor age, they remain less than 10%. It is necessary to carefully screen recipients of older organs, taking into account that the best results are obtained for patients who have alcoholic cirrhosis, are hepatitis C negative, and have a DMELD score that is less than 1,400.
肝移植候选者数量的不断增加导致等待名单上的死亡率随之上升，因此有必要修订供体选择标准并分析优化治疗结果的因素。这项对2000年至2010年在安达卢西亚进行的1802例肝移植手术的回顾性观察研究，从移植物和受者的生存率、移植类型、供体年龄以及终末期肝病供体模型（DMELD）评分等方面，分析了70岁及以上供体（n = 211）的治疗结果。最常见的移植原因是酒精性肝硬化（45.5%）、丙型肝炎肝硬化（20.4%）和肝癌（11.8%）。5年总体生存率为67%；DMELD大于1400的受者生存率显著下降（44%）。在70岁及以上供体组中，患者和移植物的总体生存率分别为57%和52%。再次移植率随供体年龄成比例增加：70至74岁为5.9%，75至79岁为9.5%，80至84岁为17.6%。在酒精性肝硬化受者亚组中，5年总体生存率为69%（P < 0.05），而丙型肝炎患者为34%（P < 0.05）。因此，扩大供体年龄选择标准是一个安全的选择，前提是获得的DMELD评分低于1400。虽然再次移植率随供体年龄逐渐增加，但仍低于10%。有必要仔细筛选老年器官的受者，要考虑到酒精性肝硬化、丙型肝炎阴性且DMELD评分低于1400的患者能获得最佳治疗效果。
