Gastaca M, Guerra M, Alvarez Martinez L, Ruiz P, Ventoso A, Palomares I, Prieto M, Matarranz A, Valdivieso A, Ortiz de Urbina J
Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Bilbao, Spain; Hepatobiliary Surgery and Liver Transplantation Unit, University of the Basque Country, Bilbao, Spain.
Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Bilbao, Spain.
Transplant Proc. 2016 Nov;48(9):2856-2858. doi: 10.1016/j.transproceed.2016.06.063.
Due to the disparity between the number of patients on the list for liver transplantation and the availability of organs, the use of older donors has become necessary. The aim of this study was to investigate the outcomes of liver transplantation using octogenarian donors.
From December 2003 to February 2016, 777 liver transplantations were performed at our institution, 33 of them (4.2%) with donors 80 years old and above. Our policy for the acceptance of these donors is based on preoperative liver function tests, donor hemodynamic stability, and intraoperative normal gross aspect. Octogenarian grafts were deliberately not assigned to retransplantations or to recipients with multiple previous surgical procedures or extensive portal thrombosis.
Mean donor age was 82.7 ± 2.1 years, with a range between 80 and 88. Only 12.1% suffered hemodynamic instability during the intensive care unit stay. Three donors (9.1%) had a history of diabetes mellitus. The mean Model for End-Stage Liver Disease score among recipients was 14.7 ± 5.6. Mean cold ischemia time was 302 ± 61 minutes. After a median follow-up of 18.5 months (range 7.5 to 47.5), no graft developed primary nonfunction. We observed hepatic artery thrombosis in 1 patient (3%) and biliary complications in 4 patients (12.5%). There was 1 case of ischemic-type biliary lesion, although it was related to hepatic artery thrombosis. Patient survival at 1 and 3 years was 90.3%, whereas graft survival was 92.6% and 86.4%, respectively.
Excellent mid-term results can be obtained after liver transplantation with octogenarian donors with strict donor selection and adequate graft allocation.
由于肝移植等待名单上的患者数量与器官供应量之间存在差距，使用老年供体已成为必要。本研究的目的是调查使用八旬及以上供体进行肝移植的结果。
2003年12月至2016年2月，我们机构共进行了777例肝移植手术，其中33例（4.2%）供体年龄在80岁及以上。我们接受这些供体的政策基于术前肝功能检查、供体血流动力学稳定性以及术中大体外观正常。八旬供体的移植物特意不分配给再次移植患者或有多次既往手术史或广泛门静脉血栓形成的受者。
供体平均年龄为82.7±2.1岁，范围在80至88岁之间。在重症监护病房住院期间，只有12.1%的供体出现血流动力学不稳定。3名供体（9.1%）有糖尿病史。受者的终末期肝病模型平均评分是14.7±5.6。平均冷缺血时间为302±61分钟。中位随访18.5个月（范围7.5至47.5个月）后，没有移植物发生原发性无功能。我们观察到1例患者（3%）发生肝动脉血栓形成，4例患者（12.5%）出现胆道并发症。有1例缺血型胆管病变，尽管它与肝动脉血栓形成有关。1年和3年的患者生存率分别为90.3%，而移植物生存率分别为92.6%和86.4%。
通过严格的供体选择和适当的移植物分配，使用八旬供体进行肝移植后可获得良好的中期结果。
