Nidoni Ravindra, Kandagaddala Rajasekhar, Agarwal Shaleen, Dey Rajesh, Chikkala Bhargava R, Gupta Subhash
Centre for Liver and Biliary Sciences, Max Superspeciality Hospital, Saket, 110017, New Delhi, India.
J Clin Exp Hepatol. 2021 Jan-Feb;11(1):3-8. doi: 10.1016/j.jceh.2020.07.007. Epub 2020 Jul 18.
With ageing population and higher prevalence of nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC) in older patients, more and more living donor liver transplants (LDLTs) are being considered in this group of patients as eligibility for deceased donor liver transplant is restricted to those aged 65 years and younger. However, the short- and long-term outcomes of this group have not been reported from India, which does not have a robust national health scheme. The aim of this study was to provide guidelines for transplant in this group.
All patients aged 60 years and older (group 1) who underwent LDLT in our centre between January 2006 and December 2017 were studied. A propensity score-matched group in 1:2 ratio was created with comparable sex and Model for End-Stage Liver Disease score (group 2). The 2 groups were compared for duration of hospital stay, surgical complications, hospital mortality and 1-, 3- and 5-year survival.
Group 1 consisted of 207 patients, and group 2 had 414 patients. The number of patients in group 1 gradually increased with time from 4 in 2006 to 33 in 2017 accounting for 15% of total cases. Group 1 had more patients with viral hepatitis, NASH and HCC, and they had a higher 30-day mortality due to cardiorespiratory complications. Although 1- and 3-year survival was similar, the 5-year survival was significantly lower in group 1.
Five-year survival was lower in the elderly group due to cardiorespiratory complications and recurrence of HCC. Outcomes in the elderly group can be improved with better patient selection and preventing HCC recurrence.
随着人口老龄化以及老年患者中非酒精性脂肪性肝炎（NASH）和肝细胞癌（HCC）的患病率升高，越来越多的老年患者被考虑进行活体肝移植（LDLT），因为尸体供肝移植的资格仅限于65岁及以下的患者。然而，印度尚未建立完善的国家医疗保健计划，该国尚未报道过这组患者的短期和长期预后情况。本研究的目的是为该组患者的肝移植提供指导方针。
对2006年1月至2017年12月期间在我们中心接受LDLT的所有60岁及以上患者（第1组）进行研究。以1:2的比例创建了一个倾向评分匹配组，其性别和终末期肝病模型评分相当（第2组）。比较两组的住院时间、手术并发症、医院死亡率以及1年、3年和5年生存率。
第1组有207例患者，第2组有414例患者。第1组患者数量随时间逐渐增加，从2006年的4例增加到2017年的33例，占总病例数的15%。第1组中患有病毒性肝炎、NASH和HCC的患者更多，且因心肺并发症导致的30天死亡率更高。尽管1年和3年生存率相似，但第1组的5年生存率显著较低。
由于心肺并发症和HCC复发，老年组的5年生存率较低。通过更好地选择患者和预防HCC复发，可以改善老年组的预后。
