活体供肝肝移植使用老年供体：HCV 复发导致长期移植物丢失增加。

Live donor liver transplantation with older donors: Increased long-term graft loss due to HCV recurrence.

机构信息

Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada.

Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.

出版信息

Clin Transplant. 2018 Aug;32(8):e13304. doi: 10.1111/ctr.13304. Epub 2018 Jul 16.

DOI:10.1111/ctr.13304

PMID:29947154

Abstract

Using our prospectively collected database all adult hepatitis C virus (HCV)-positive patients receiving an adult-to-adult LDLT between October 2000 and May 2014 were identified. Outcome of LDLT with grafts from younger (<50 years=128) vs older donors (≥50 years=31) was compared. Post-transplant graft function, postoperative complications and incidence of HCV recurrence were evaluated. Long-term graft and patient survival was calculated. No difference in graft function was observed between younger and older grafts. Overall complications were similar between both groups. The severity of complications determined by the Dindo-Clavien score was similar. Graft loss from HCV recurrence was significantly less frequent in younger grafts (18% vs 62%, P = 0.001). Young vs older livers had a trend toward improved 1-, 5-, and 10-year graft survival (89% vs 87%, 77% vs 69%, 70% vs 55%, P = 0.096), while patient survival was comparable between both groups (91% vs 90%, 78% vs 69%, 71% vs 60%, P = 0.25). In conclusion, LDLT with older vs younger grafts are more frequently associated with long-term graft loss due to HCV recurrence. Differences in graft survival might be more prominent with prolonged (≥5-year) follow-up. Living donor-recipient matching is particularly important for younger HCV-positive recipients.

摘要

使用我们前瞻性收集的数据库，确定了 2000 年 10 月至 2014 年 5 月期间所有接受成人对成人 LDLT 的成年丙型肝炎病毒（HCV）阳性患者。比较了来自年轻（<50 岁=128）与年长（≥50 岁=31）供体的 LDLT 的结果。评估了 LDLT 后的移植物功能、术后并发症和 HCV 复发的发生率。计算了长期移植物和患者存活率。年轻和年长供体的移植物功能无差异。两组总体并发症相似。Dindo-Clavien 评分确定的并发症严重程度相似。年轻供体的 HCV 复发导致移植物丢失的频率明显较低（18%对 62%，P=0.001）。年轻供体与年长供体的移植物 1 年、5 年和 10 年存活率呈上升趋势（89%对 87%，77%对 69%，70%对 55%，P=0.096），而两组患者存活率相当（91%对 90%，78%对 69%，71%对 60%，P=0.25）。总之，与年轻供体相比，年长供体的 LDLT 更常因 HCV 复发导致长期移植物丢失。随着随访时间的延长（≥5 年），移植物存活率的差异可能更为明显。对于年轻的 HCV 阳性受者，活体供者与受者的匹配尤为重要。