Dopazo Cristina, Bilbao Itxarone, Castells Lluis, Caralt Mireia, Fernández de Sevilla Elena, Lázaro José Luis, Charco Ramón
Department of HPB Surgery and Transplants, Hospital Universitario Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain.
Hepatology Unit, Department of Internal Medicine, Hospital Vall d'Hebron, CIBERehd, Universidad Autonoma de Barcelona, Barcelona, Spain.
Ann Transplant. 2016 Nov 18;21:708-716. doi: 10.12659/aot.900767.
BACKGROUND The characteristics of liver donors have changed over the last decade owing to the shortage of organs and high mortality on the waiting list, leading to wider use of extended-criteria donors, including older donors. The aim of this study was to evaluate the effect of matching donor-recipient age on morbidity at 1 year post-transplant and on long-term patient and graft survival. MATERIAL AND METHODS Retrospective study from a prospectively-obtained database including adult patients who had received a primary liver transplant (LT) from whole graft of brain-dead donors. Recipients were divided into 2 age groups: <60 years and ≥60 years. Both groups were sub-divided according to donor age (younger than 60 years and 60 years or older). A propensity score analysis was performed to further adjust for baseline differences between recipients and donors. RESULTS We analyzed 642 patients who had LT performed between January 2000 and December 2013. No differences were observed in 1-year morbidity (hospital stay, rejection, surgical complications, and retransplant) between groups. Although patient and graft survival was significantly impaired in the older donor/older recipient group on Kaplan-Meier analysis (p=0.004), the propensity score analysis showed that donor age ≥60 years did not increase the risk of death for recipients aged ≥60 (HR1.40, p 0.074) and <60 years (HR 1.47, p 0.070). CONCLUSIONS Older donor age did not negatively affect survival regardless of recipient age, and comparable outcomes were achieved without an increased rate of complications.
在过去十年中，由于器官短缺以及等待名单上的高死亡率，肝供体的特征发生了变化，这导致了包括老年供体在内的扩大标准供体的更广泛使用。本研究的目的是评估供体与受体年龄匹配对移植后1年发病率以及患者和移植物长期存活的影响。
对一个前瞻性获取的数据库进行回顾性研究，该数据库包括接受脑死亡供体全肝移植（LT）的成年患者。将受体分为两个年龄组：<60岁和≥60岁。两组再根据供体年龄进一步细分（<60岁和60岁及以上）。进行倾向评分分析以进一步调整受体和供体之间的基线差异。
我们分析了2000年1月至2013年12月期间进行肝移植的642例患者。各年龄组之间在1年发病率（住院时间、排斥反应、手术并发症和再次移植）方面未观察到差异。尽管在Kaplan-Meier分析中，老年供体/老年受体组的患者和移植物存活率显著受损（p = 0.004），但倾向评分分析表明，供体年龄≥60岁并未增加≥60岁（HR 1.40，p 0.074）和<60岁（HR 1.47，p 0.070）受体的死亡风险。
无论受体年龄如何，供体年龄较大对存活率没有负面影响，并且在不增加并发症发生率的情况下可获得相当的结果。
