Department of General, Visceral, and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany.
Transplantation. 2020 Apr;104(4):779-787. doi: 10.1097/TP.0000000000002970.
Despite steadily increasing donor age, there are no general guidelines for the use of organs from elderly donors in liver transplantation. This study focuses on identifying the recipients who are less affected from an old-donor organ graft and conversely in whom a rather unfavorable outcome is expected because of high donor age.
Forty-eight thousand two hundred sixty-one adult liver transplantations, performed between 2000 and 2017 and reported to the Collaborative Transplant Study, were analyzed.
The proportion of ≥65-year-old donors has risen to >33% in recent years. The donor age has an approximately linear influence on graft survival. On average, each year's rise in the donor age was associated with a 0.9% increase in the risk of graft loss (hazard ratio [HR], 1.009; P < 0.001). The impact of donor age was strong in patients with hepatitis C-related cirrhosis (HR, 1.013; P < 0.001), substantial in patients with alcoholic cirrhosis (HR, 1.007; P < 0.001) and rather weak in patients with hepatocellular carcinoma (HR, 1.003; P = 0.038). The increase in the risk of graft loss per year rise in donor age was 1.4% for 18 to 49 year olds, 1.0% for middle-aged, and only 0.4% for ≥60-year-old recipients (all P < 0.001).
Consequently, older recipients and especially patients with hepatocellular carcinoma seem to be less affected by an increased donor age, whereas the donor age is an important factor in all other patient groups.
尽管供体年龄稳步增加，但在肝移植中使用老年供体器官尚无普遍指南。本研究旨在确定受者受老年供体器官移植物影响较小的人群，相反，由于供体年龄较高，这些受者的预后较差。
分析了 2000 年至 2017 年期间向协作移植研究报告的 48261 例成人肝移植。
近年来，≥65 岁供体的比例已上升至>33%。供体年龄对移植物存活率有近似线性影响。平均而言，供体年龄每年增加 0.9%，移植物丢失的风险增加 0.9%（风险比[HR]，1.009；P<0.001）。供体年龄的影响在丙型肝炎相关肝硬化患者中较强（HR，1.013；P<0.001），在酒精性肝硬化患者中较大（HR，1.007；P<0.001），在肝细胞癌患者中较弱（HR，1.003；P=0.038）。供体年龄每年增加 1 岁，移植物丢失风险增加 1.4%，年龄在 18 至 49 岁之间，增加 1.0%，年龄在中年，仅增加 0.4%，年龄≥60 岁（均 P<0.001）。
因此，老年受者，尤其是肝细胞癌患者，受供体年龄增加的影响较小，而供体年龄是所有其他患者群体的重要因素。
