Gajate Martín L, Martín Grande A, Parise Roux D, González Cibrián C, Fernández Martín C, Rodríguez Gandía M A, López Buenadicha A
Department of Anesthesiology and Intensive Care, Madrid, Spain.
Department of Anesthesiology and Intensive Care, Madrid, Spain.
Transplant Proc. 2018 Jan-Feb;50(1):184-191. doi: 10.1016/j.transproceed.2017.12.002.
There are increasingly more patients awaiting liver transplantation while the number of donors has remained stable. It has been proven that grafts from donors older than 60 years have comparable results with those from younger donors. It is unclear whether this is so with donors older than 80 years old.
This was a retrospective study of all adult liver transplantations at our institution between March 2011 and December 2015. We compared 1-, 3-, 6-, and 12-month graft survival rates from donors <80 years and ≥80 years. We also compared postoperative complications: infections, acute kidney injury, need for readmission in the intensive care unit, length of stay, mechanical ventilation, and specific graft complications. We considered differences in each age group regarding the presence of hepatitis C virus (HCV).
Of 177 recipients, 38 received grafts from octogenarian donors (21.5%). Survival rates were very similar in the groups (97%, 93%, 91%, and 87% for donors <80 years and 95%, 92%, 87%, and 76% for donors ≥80 years). Although for younger grafts, 1-year survival rates were slightly lower for HCV+ patients (80% vs 89%; log-rank 0.205), this difference does not exist for elderly donors. The incidence of postoperative complications was similar in both groups.
Livers from octogenarian donors are acceptable for liver transplantation provided that thorough assessment and selection is made by avoiding other known poor prognosis factors. The presence of HCV did not affect survival rates.
等待肝移植的患者越来越多,而供体数量保持稳定。已证实,60岁以上供体的移植物与年轻供体的移植物效果相当。80岁以上供体的情况是否如此尚不清楚。
这是一项对2011年3月至2015年12月期间在本机构进行的所有成人肝移植的回顾性研究。我们比较了年龄小于80岁和年龄大于等于80岁的供体1个月、3个月、6个月和12个月的移植物存活率。我们还比较了术后并发症:感染、急性肾损伤、重症监护病房再次入院需求、住院时间、机械通气以及特定的移植物并发症。我们考虑了各年龄组中丙型肝炎病毒(HCV)感染情况的差异。
177例受者中,38例接受了来自80岁以上供体的移植物(21.5%)。两组的存活率非常相似(年龄小于80岁的供体分别为97%、93%、91%和87%,年龄大于等于80岁的供体分别为95%、92%、87%和76%)。虽然对于年轻移植物,HCV阳性患者的1年存活率略低(80%对89%;对数秩检验P = 0.205),但老年供体不存在这种差异。两组术后并发症的发生率相似。
只要通过避免其他已知的不良预后因素进行全面评估和选择,80岁以上供体的肝脏可用于肝移植。HCV感染的存在并不影响存活率。