Dickson Kevin M, Martins Paulo N
Department of Surgery, Division of Transplantation, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01605, USA.
Transplant Rev (Orlando). 2020 Jul;34(3):100549. doi: 10.1016/j.trre.2020.100549. Epub 2020 May 11.
The aging process causes detrimental changes in a variety of organ systems. These changes include: lesser ability to cope with stress, impaired repair mechanisms and decreased cellular functional reserve capacity. Not surprisingly, aging has been associated with increased susceptibility of donor heart and kidneys grafts to ischemia reperfusion injury (IRI). In the context of liver transplantation, however, the effect of donor age seems to be less influential in predisposing the graft to IRI. In fact, a widely comprehensive understanding of IRI in the aged liver has yet to be agreed upon in the literature. Nevertheless, there have been many reported implications of increased liver donor age with poor clinical outcomes besides IRI. These other poor outcomes include: earlier HCV recurrence, increased rates of acute rejection and greater resistance to tolerance induction. While these other correlations have been identified, it is important to re-emphasize the fact that a unified consensus in regard to liver donor age and IRI has not yet been reached among researchers in this field. Many researchers have even demonstrated that the extent of IRI in aged livers can be ameliorated by careful donor selection, strict allocation or novel therapeutic modalities to decrease IRI. Thus, the goals of this review paper are twofold: 1) To delineate and summarize the conflicting data in regard to liver donor age and IRI. 2) Suggest that careful donor selection, appropriate allocation and strategic effort to minimize IRI can reduce the frequency of a variety of poor outcomes with aged liver donations.
衰老过程会导致多种器官系统发生有害变化。这些变化包括：应对压力的能力下降、修复机制受损以及细胞功能储备能力降低。毫不奇怪，衰老与供体心脏和肾脏移植对缺血再灌注损伤（IRI）的易感性增加有关。然而，在肝移植方面，供体年龄对移植物发生IRI的影响似乎较小。事实上，文献中尚未就老年肝脏IRI达成广泛全面的共识。尽管如此，除了IRI之外，还有许多报道指出供体肝脏年龄增加与临床预后不良有关。这些其他不良后果包括：丙型肝炎病毒（HCV）复发更早、急性排斥反应发生率增加以及对诱导耐受的抵抗力增强。虽然已经确定了这些其他相关性，但重要的是要再次强调，该领域的研究人员尚未就肝脏供体年龄与IRI达成统一共识。许多研究人员甚至表明，通过仔细选择供体、严格分配或采用新的治疗方法来减少IRI，可以改善老年肝脏的IRI程度。因此，本综述文章的目标有两个：1）描述和总结关于肝脏供体年龄与IRI的相互矛盾的数据。2）建议仔细选择供体、适当分配以及为尽量减少IRI而做出的战略努力，可以降低老年肝脏捐赠出现各种不良后果的频率。
