Kim Seok-Hwan, Park Gil-Chun, Hwang Shin, Ahn Chul-Soo, Kim Ki-Hum, Moon Deok-Bog, Ha Tae-Yong, Song Gi-Won, Jung Dong-Hwan, Cho Hwi-Dong, Kwon Jae-Hyun, Jung Yong-Kyu, Ha Su-Min, Kang Sang-Hyun, Lee Sung-Gyu
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Surgery, Chungnam National University Hospital, Daejeon, South Korea.
Ann Transplant. 2018 Nov 16;23:802-807. doi: 10.12659/AOT.911550.
BACKGROUND We assessed the prognostic impact of donor age on the outcome of adult living donor liver transplantation (LDLT). MATERIAL AND METHODS The study population comprised adult donor and recipients of right lobe grafts for LDLT performed from January 2005 to December 2016. There were 35 living donors aged ≥50 years (old-age donor group). As a control group, donors in their 20s (young-age donor group) were selected after one-to-one propensity score matching based on sex, model for end-stage liver disease (MELD) score, and primary diagnosis. RESULTS Donor age was 52.5±1.5 years versus 25.4±3.1 years in the old- and young-age donor groups, respectively. Remnant volumes of the 2 groups were 38.9±3.0% versus 38.1±2.9%, respectively (p=0.98). One-month regeneration rate of the remnant liver was 101.1±10.6% versus 104.5±11.8%, respectively (p=0.08), and there was no significant difference in the incidences of donor complications. Mean MELD score was 15 versus 14, respectively (p=0.82). Graft-to-recipient weight ratio was 1.02±0.43 versus 0.91±0.63, respectively (p=0.28). In the recipients, biliary complication occurred in 11.4% versus 8.6%, respectively (p=0.12), and there was no difference in 5-year survival rates of both groups (p=0.15). The 1-week and 1-month regeneration rates of the remnant left liver were 71.6±9.9% and 100.1±10.6% in the old-age group, respectively, whereas those were 80.2±12.1% and 104.5±11.8% in the young-age group, respectively (p=0.08). CONCLUSIONS Right lobe grafts from donors aged ≥50 years showed the usual recovery of graft function but rather delayed liver regeneration. Thus, old-aged donors should be selected prudently after consideration of hepatic resection rate, graft size, and hepatic steatosis.
我们评估了供体年龄对成人活体肝移植(LDLT)预后的影响。
研究人群包括2005年1月至2016年12月期间接受右叶移植的成人供体和受体。有35名年龄≥50岁的活体供体(老年供体组)。作为对照组,根据性别、终末期肝病模型(MELD)评分和初步诊断进行一对一倾向评分匹配后,选择20多岁的供体(年轻供体组)。
老年和年轻供体组的供体年龄分别为52.5±1.5岁和25.4±3.1岁。两组的残余体积分别为38.9±3.0%和38.1±2.9%(p=0.98)。残余肝的1个月再生率分别为101.1±10.6%和104.5±11.8%(p=0.08),供体并发症发生率无显著差异。平均MELD评分分别为15和14(p=0.82)。移植物与受体重量比分别为1.02±0.43和0.91±0.63(p=0.28)。在受体中,胆道并发症发生率分别为11.4%和8.6%(p=0.12),两组的5年生存率无差异(p=0.15)。老年组残余左肝的1周和1个月再生率分别为71.6±9.9%和100.1±10.6%,而年轻组分别为80.2±12.1%和104.5±11.8%(p=0.08)。
年龄≥50岁供体的右叶移植物显示出移植物功能的正常恢复,但肝再生延迟。因此,在考虑肝切除率、移植物大小和肝脂肪变性后,应谨慎选择老年供体。