Ekser Burcin, Goggins William C, Fridell Jonathan A, Mihaylov Plamen, Mangus Richard S, Lutz Andrew J, Soma Daiki, Ghabril Marwan S, Lacerda Marco A, Powelson John A, Kubal Chandrashekhar A
Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN.
Transplant Direct. 2020 May 28;6(6):e563. doi: 10.1097/TXD.0000000000001011. eCollection 2020 Jun.
Elderly recipients (≥70 y) account for 2.6% of all liver transplants (LTs) in the United States and have similar outcomes as younger recipients. Although the rate of elderly recipients in combined liver-kidney transplant (CLKT) is similar, limited data are available on how elderly recipients perform after CLKT.
We have previously shown excellent outcomes in CLKT using delayed kidney transplant (Indiana) Approach (mean kidney cold ischemia time = 53 ± 14 h). Between 2007 and 2018, 98 CLKTs were performed using the Indiana Approach at Indiana University (IU) and the data were retrospectively analyzed. Recipients were subgrouped based on their age: 18-45 (n = 16), 46-59 (n = 34), 60-69 (n = 40), and ≥70 years (n = 8).
Overall, more elderly patients received LT at IU (5.2%) when compared nationally (2.6%). The rate of elderly recipients in CLKT at IU was 8.2% (versus 2% Scientific Registry of Transplant Recipient). Recipient and donor characteristics were comparable between all age groups except recipient age and duration of dialysis. Patient survival at 1 and 3 years was similar among younger age groups, whereas patient survival was significantly lower in elderly recipients at 1 (60%) and 3 years (40%) ( = 0.0077). Control analyses (replicating Scientific Registry of Transplant Recipient's survival stratification: 18-45, 46-64, ≥65 y) showed similar patient survival in all age groups.
Although LT can be safely performed in elderly recipients, extreme caution is needed in CLKT due to the magnitude of operation.
在美国，老年受者（≥70岁）占所有肝移植（LT）的2.6%，其移植结局与年轻受者相似。尽管肝肾联合移植（CLKT）中老年受者的比例相似，但关于老年受者在CLKT后的表现的数据有限。
我们之前已经证明，采用延迟肾移植（印第安纳）方法进行CLKT可取得良好的结局（平均肾冷缺血时间=53±14小时）。2007年至2018年期间，印第安纳大学（IU）采用印第安纳方法进行了98例CLKT，并对数据进行了回顾性分析。根据受者年龄将其分为亚组：18 - 45岁（n = 16）、46 - 59岁（n = 34）、60 - 69岁（n = 40）和≥70岁（n = 8）。
总体而言，与全国水平（2.6%）相比，IU接受LT的老年患者更多（5.2%）。IU接受CLKT的老年受者比例为8.2%（而移植受者科学登记处为2%）。除受者年龄和透析时间外，所有年龄组的受者和供者特征具有可比性。较年轻年龄组1年和3年的患者生存率相似，而老年受者1年（60%）和3年（40%）的患者生存率显著较低（P = 0.0077）。对照分析（复制移植受者科学登记处的生存分层：18 - 45岁、46 - 64岁、≥65岁）显示所有年龄组的患者生存率相似。
虽然老年受者可以安全地进行肝移植，但由于手术规模较大，肝肾联合移植需要格外谨慎。
