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在年龄在 70 岁及以上的供体中使用循环死亡后捐献的肝脏进行移植,可以实现可比较的移植物存活率:一项长期的英国国家分析。

Comparable graft survival is achievable with the usage of donation after circulatory death liver grafts from donors at or above 70 years of age: A long-term UK national analysis.

机构信息

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.

出版信息

Am J Transplant. 2021 Jun;21(6):2200-2210. doi: 10.1111/ajt.16409. Epub 2021 Jan 21.

Abstract

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.

摘要

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。

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