Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Korea University Medical Center, University of Korea College of Medicine, Seoul, Korea.
Am J Transplant. 2017 Nov;17(11):2890-2900. doi: 10.1111/ajt.14355. Epub 2017 Jun 19.
Over the past two decades, the age of liver transplantation (LT) recipients has been increasing. We reviewed our experience with LT for patients aged ≥70 years (range: 70-78 years) and investigated the feasibility of performing LT, especially living donor LT (LDLT), for older patients. We retrospectively reviewed the medical records of 25 patients (15 LDLT recipients, 10 deceased donor LT recipients) aged ≥70 years who underwent LT from January 2000 to April 2016. Their perioperative morbidity rate was 28.0%, and the in-hospital mortality rate was 16.0%; these results were comparable to those of matched patients in their 60s (n = 73; morbidity, p = 0.726; mortality, p = 0.816). For patients in their 70s, the 1- and 5-year patient survival rates were 84.0% and 69.8%, and the 1- and 5-year graft survival rates were 83.5% and 75.1%, respectively. Comparisons of patient and graft survival rates between matched patients in their 60s and 70s showed no statistically significant differences (patient survival, p = 0.372; graft survival, p = 0.183). Our experience suggests that patients aged ≥70 years should not be excluded from LT, or even LDLT, based solely on age and implies that careful selection of recipients and donors as well as meticulous surgical technique are necessary for successful results.
在过去的二十年中,肝移植(LT)受者的年龄一直在增加。我们回顾了我们对年龄≥70 岁(范围:70-78 岁)的 LT 患者的经验,并研究了对老年患者进行 LT 的可行性,特别是活体供肝 LT(LDLT)。我们回顾性分析了 2000 年 1 月至 2016 年 4 月期间 25 名年龄≥70 岁的患者(15 名 LDLT 受者,10 名尸体供肝 LT 受者)的医疗记录。他们的围手术期发病率为 28.0%,住院死亡率为 16.0%;这些结果与他们 60 多岁的匹配患者(n=73)相似(发病率,p=0.726;死亡率,p=0.816)。对于 70 多岁的患者,1 年和 5 年的患者生存率分别为 84.0%和 69.8%,1 年和 5 年的移植物生存率分别为 83.5%和 75.1%。与 60 多岁的匹配患者相比,患者和移植物生存率无统计学差异(患者生存率,p=0.372;移植物生存率,p=0.183)。我们的经验表明,不能仅仅根据年龄将年龄≥70 岁的患者排除在 LT 之外,甚至排除 LDLT,这意味着需要仔细选择受者和供者,并采用精细的手术技术,才能取得成功。