Department of Surgery, Duke University Medical Center, Durham, NC.
Ann Surg. 2019 Aug;270(2):333-339. doi: 10.1097/SLA.0000000000002876.
To investigate trends in long-term graft and patient outcomes following liver transplantation using grafts from donors ≥60 years old.
The scarcity of donor livers has led to increased utilization of organs from donors ≥60 years old. However, few studies have examined how long-term transplant outcomes from older donors have evolved over time.
The OPTN/UNOS database was queried for all first-time isolated adult liver transplants. We identified 14,796 adult liver transplant using donors ≧60-year-old suitable for analysis from 1990 to 2014. Cohorts were then developed based on 5-year intervals of transplant date. Kaplan-Meier analysis was used to compare graft and patient survival for recipients from older donor across each 5-year era.
Utilization of donor grafts ≥60 years old increased steadily for the first 15 years of the study, but has leveled off over the last 10 years. Comparison of the earliest and latest eras in the study was notable for an increase in median recipient age (51 vs. 59, P < 0.001) and reduction in median cold ischemic time (10 vs. 6 h, P = 0.001). Unadjusted 5-year graft and patient survival has improved significantly over time (P < 0.0001). More importantly, the discrepancy in survival between older and younger grafts has narrowed substantially over time (P < 0.0001).
This study demonstrates significant improvement in transplant outcomes with donor grafts ≥60-years old and supports increased but judicious use of extended criteria donors liver grafts. Improved patient selection and reduction in cold ischemia time appear to be contributing factors.
研究使用≥60 岁供体进行肝移植后的长期移植物和患者结局的趋势。
供体肝脏的稀缺性导致≥60 岁供体器官的利用率增加。然而，很少有研究探讨从年长供体获得的长期移植结果随时间的变化。
在 OPTN/UNOS 数据库中查询了所有首次进行的成人孤立性肝移植。我们从 1990 年至 2014 年确定了 14796 例适合分析的≥60 岁成人肝移植使用供体。然后根据移植日期的 5 年间隔开发队列。Kaplan-Meier 分析用于比较每个 5 年时期来自年长供体的受者的移植物和患者存活率。
在研究的前 15 年，≥60 岁供体的使用稳步增加，但在过去 10 年中趋于平稳。研究中最早和最新时期的比较值得注意的是受体中位年龄增加（51 岁对 59 岁，P <0.001）和中位冷缺血时间减少（10 小时对 6 小时，P = 0.001）。未调整的 5 年移植物和患者存活率随时间显著提高（P <0.0001）。更重要的是，随着时间的推移，年长和年轻供体之间的存活率差异大大缩小（P <0.0001）。
本研究表明，使用≥60 岁供体的肝移植的移植结果显著改善，并支持增加但明智地使用扩展标准供体的肝移植物。改善患者选择和减少冷缺血时间似乎是促成因素。
