Department of Surgery, Division of Solid Organ Transplantation, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Institute of Liver Studies, King's College Hospital, London, UK.
Am J Transplant. 2021 Jun;21(6):2200-2210. doi: 10.1111/ajt.16409. Epub 2021 Jan 21.
The aim of the study was to assess the UK donation after circulatory death (DCD) liver transplant experience from donors ≥70 years. Nationwide UK DCD retrospective analysis was conducted between 2001 and 2015 (n = 1163). Recipients were divided into group 1 vs. group 2 (donors 70≥ vs. <70 years, respectively). group 1 (n = 69, 5.9%) recipients were older (median 59 vs. 55 years, p = .001) and had longer waitlist time (128 vs. 84 days; p = .039). 94.2% of group 1 clustered in London and Birmingham, where the two busiest centers are located. group 1 allografts had higher UKDRI and UK DCD Risk Scores but similar WIT and CIT and were more likely to have been imported. Both groups had similar 1-, 3-, and 5-year graft survival (group 1, 90%, 81.4%, and 74% vs. group 2, 88.6%, 81.4%, and 78.6%, respectively; p = .54). Both groups had similar ICU stay length (p = .22), 3-month hepatic artery thrombosis rates (4.4% vs 4.0%; p = .9), and 12-month readmission rates for all biliary complications (20.3% vs 25.7%; p = .32). This study demonstrates that acceptable outcomes are achievable using older grafts in a highly selected cohort at experienced centers. Advanced age should not be an absolute contraindication to utilizing a DCD graft from donors aged ≥70 years.
本研究旨在评估英国≥70 岁循环死亡(DCD)供肝移植的经验。在 2001 年至 2015 年间,对英国全国范围内的 DCD 进行了回顾性分析(n=1163)。将受者分为第 1 组和第 2 组(供者分别为≥70 岁和<70 岁)。第 1 组(n=69,5.9%)受者年龄较大(中位数 59 岁 vs. 55 岁,p=0.001),等待时间较长(128 天 vs. 84 天;p=0.039)。第 1 组 94.2%的患者集中在伦敦和伯明翰,这两个繁忙的中心所在地。第 1 组的同种异体移植物的 UKDRI 和 UK DCD 风险评分较高,但 WIT 和 CIT 相似,且更有可能是进口的。两组的 1 年、3 年和 5 年移植物存活率相似(第 1 组分别为 90%、81.4%和 74%,第 2 组分别为 88.6%、81.4%和 78.6%,p=0.54)。两组患者的 ICU 住院时间相似(p=0.22),3 个月肝动脉血栓形成率(4.4%比 4.0%;p=0.9)和 12 个月胆道并发症再入院率(20.3%比 25.7%;p=0.32)相似。本研究表明,在经验丰富的中心,通过对高度选择的患者使用较老的移植物,可获得可接受的结果。高龄不应成为使用≥70 岁 DCD 供体移植物的绝对禁忌。