Imamura Hajime, Hidaka Masaaki, Soyama Akihiko, Kitasato Amane, Adachi Tomohiko, Ono Shinichiro, Natsuda Koji, Hara Takanobu, Kugiyama Tota, Baimakhanov Zhassulan, Okada Satomi, Fujita Fumihiko, Kanetaka Kengo, Takatsuki Mitsuhisa, Kuroki Tamotsu, Eguchi Susumu
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Transplant Direct. 2017 Jun 6;3(7):e168. doi: 10.1097/TXD.0000000000000688. eCollection 2017 Jul.
Given the expected increase in the number of elderly recipients, details regarding how clinical factors influence the outcome in living donor liver transplantation (LDLT) for the elderly remain unclear. We examined the survival outcomes according to the results of donor age-based and graft volume-based analyses and assessed the impact of prognostic factors on the survival after LDLT for elderly recipients.
The 198 adult recipients were classified into 2 groups: an elderly group (n = 70, E group; ≥ 60 years of age) and a younger group (n = 128, Y group; <60 years of age). We analyzed the prognostic factors for the survival in the E group and the survival rate for both groups at several follow-up points and conducted subgroup analyses in the E group by combining the donor age (≥50 vs <50 years) and graft weight (GW)/standard liver volume (SLV) (≥40% vs <40%).
Donor age (hazard ratio [HR], 2.17; = 0.062) and GW/SLV (HR, 1.80; = 0.23) tended to have a high HR in the E group. The overall patient survival rates at 1, 3, and 5 years were 78.3%, 73.0%, and 61.0% in the E group, and 82.0%, 75.1%, and 69.2% in the Y group, respectively ( = 0.459). However, the outcomes tended to be worse in recipients of grafts from donors ≥50 years of age than in those with grafts from younger donors with GW/SLV < 40% ( = 0.048).
A worse outcome might be associated with aging of the donor, which leads to impairment of the graft function and liver regeneration. Both the graft volume and donor age should be considered when choosing grafts for LDLT in elderly patients.
鉴于老年受者数量预计会增加，关于临床因素如何影响老年活体肝移植（LDLT）结局的细节仍不清楚。我们根据基于供体年龄和基于移植物体积的分析结果检查了生存结局，并评估了预后因素对老年受者LDLT术后生存的影响。
198名成年受者分为两组：老年组（n = 70，E组；≥60岁）和年轻组（n = 128，Y组；<60岁）。我们分析了E组生存的预后因素以及两组在几个随访点的生存率，并通过结合供体年龄（≥50岁与<50岁）和移植物重量（GW）/标准肝体积（SLV）（≥40%与<40%）在E组中进行亚组分析。
在E组中，供体年龄（风险比[HR]，2.17；P = 0.062）和GW/SLV（HR，1.80；P = 0.23）倾向于具有较高的HR。E组1年、3年和5年的总体患者生存率分别为78.3%、73.0%和61.0%，Y组分别为82.0%、75.1%和69.2%（P = 0.459）。然而，来自≥50岁供体的移植物受者的结局往往比来自GW/SLV<40%的年轻供体移植物的受者更差（P = 0.048）。
较差的结局可能与供体衰老有关，这会导致移植物功能和肝再生受损。在为老年患者选择LDLT移植物时，应同时考虑移植物体积和供体年龄。
