Jiménez-Romero Carlos, Cambra Felix, Caso Oscar, Manrique Alejandro, Calvo Jorge, Marcacuzco Alejandro, Rioja Paula, Lora David, Justo Iago
Carlos Jiménez-Romero, Felix Cambra, Oscar Caso, Alejandro Manrique, Jorge Calvo, Alejandro Marcacuzco, Paula Rioja, David Lora, Iago Justo, HPB Surgery and Abdominal Organ Transplantation Unit, University Hospital "Doce de Octubre", 28041 Madrid, Spain.
World J Gastroenterol. 2017 May 7;23(17):3099-3110. doi: 10.3748/wjg.v23.i17.3099.
To analyse the impact of octogenarian donors in liver transplantation.
We present a retrospective single-center study, performed between November 1996 and March 2015, that comprises a sample of 153 liver transplants. Recipients were divided into two groups according to liver donor age: recipients of donors ≤ 65 years (group A; = 102), and recipients of donors ≥ 80 years (group B; = 51). A comparative analysis between the groups was performed. Quantitative variables were expressed as mean values and SD, and qualitative variables as percentages. Differences in properties between qualitative variables were assessed by test. Comparison of quantitative variables was made by -test. Graft and patient survivals were estimated using the Kaplan-Meier method.
One, 3 and 5-year overall patient survival was 87.3%, 84% and 75.2%, respectively, in recipients of younger grafts 88.2%, 84.1% and 66.4%, respectively, in recipients of octogenarian grafts ( = 0.748). One, 3 and 5-year overall graft survival was 84.3%, 83.1% and 74.2%, respectively, in recipients of younger grafts 84.3%, 79.4% and 64.2%, respectively, in recipients of octogenarian grafts ( = 0.524). After excluding the patients with hepatitis C virus cirrhosis (16 in group A and 10 in group B), the 1, 3 and 5-year patient ( = 0.657) and graft ( = 0.419) survivals were practically the same in both groups. Multivariate Cox regression analysis demonstrated that overall patient survival was adversely affected by cerebrovascular donor death, hepatocarcinoma, and recipient preoperative bilirubin, and overall graft survival was adversely influenced by cerebrovascular donor death, and recipient preoperative bilirubin.
The standard criteria for utilization of octogenarian liver grafts are: normal gross appearance and consistency, normal or almost normal liver tests, hemodynamic stability with use of < 10 μg/kg per minute of vasopressors before procurement, intensive care unit stay < 3 d, CIT < 9 h, absence of atherosclerosis in the hepatic and gastroduodenal arteries, and no relevant histological alterations in the pre-transplant biopsy, such as fibrosis, hepatitis, cholestasis or macrosteatosis > 30%.
分析八旬老人供肝在肝移植中的影响。
我们进行了一项回顾性单中心研究，研究时间为1996年11月至2015年3月，共纳入153例肝移植样本。根据供肝年龄将受者分为两组：供者年龄≤65岁的受者（A组；n = 102）和供者年龄≥80岁的受者（B组；n = 51）。对两组进行了比较分析。定量变量以平均值和标准差表示，定性变量以百分比表示。定性变量之间属性的差异通过检验进行评估。定量变量的比较采用t检验。采用Kaplan-Meier方法估计移植物和患者的生存率。
年轻移植物受者的1年、3年和5年总体患者生存率分别为87.3%、84%和75.2%，八旬老人移植物受者分别为88.2%、84.1%和66.4%（P = 0.748）。年轻移植物受者的1年、3年和5年总体移植物生存率分别为84.3%、83.1%和74.2%，八旬老人移植物受者分别为84.3%、79.4%和64.2%（P = 0.524）。排除丙型肝炎病毒肝硬化患者（A组16例，B组10例）后，两组的1年、3年和5年患者（P = 0.657）和移植物（P = 0.419）生存率实际相同。多因素Cox回归分析表明，总体患者生存率受到脑血管供者死亡、肝癌和受者术前胆红素的不利影响，总体移植物生存率受到脑血管供者死亡和受者术前胆红素的不利影响。
八旬老人肝移植物的使用标准为：大体外观和质地正常，肝功能检查正常或接近正常，获取前使用血管升压药剂量<10μg/kg每分钟时血流动力学稳定，重症监护病房停留时间<3天，冷缺血时间<9小时，肝动脉和胃十二指肠动脉无动脉粥样硬化，移植前活检无相关组织学改变，如纤维化、肝炎、胆汁淤积或大脂肪变>30%。
