Wang Wenchao, Liu Zhengtao, Qian Junjie, Xu Jun, Que Shuping, Zhuang Li, Geng Lei, Zhou Lin, Zheng Shusen
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
National Health Commission Key Laboratory of Combined Multi-organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Med (Lausanne). 2021 Mar 4;8:596552. doi: 10.3389/fmed.2021.596552. eCollection 2021.
Donor age affects allograft quality and the prognosis of recipients after liver transplantation (LT). Clinicians have assessed the quality of grafts from older donors based on their appearance and texture, with no reliable quantitative evidence. Our study aimed to assess the quantitative impact of donor age on post-transplant outcomes and its safety threshold for LT, based on the published literature. Relevant studies were retrieved from the Embase, PubMed, and ISI Web of Science databases. Pooled dichotomous relative risks (RRs) were calculated using metan. Continuous RRs were calculated using a two-stage random-effects model. Eleven studies including 30,691 LT cases were included for further analysis. For categorical comparison, the RR of death within the first post-transplant year was significantly higher among patients who received grafts from older donors. Similarly, the RR of graft failure (GF) was increased within the 3 years after transplantation. For continuous comparison, advanced donor age affected transplant outcomes in a linear manner ( > 0.05). A 10-year increment in donor age was associated with RRs 1.10, 1.12, 1.15, 1.10, and 1.08 for 90-day, 180-day, 1-year, 3-year, and 5-year patient mortality and 1.08, 1.06, 1.10, 1.11, and 1.12, for 90-day, 180-day, 1-year, 2-year, and 3-year GF, respectively (all < 0.05). A spline model showed that transplants using grafts from donors <43 years old were not associated with age-related risks ( > 0.05). The risk of GF was increased in subgroups with fewer LT cases, longer cold ischemic time, fewer male donors, and recipients with viral hepatitis ( < 0.05). Donor age might affect post-LT outcomes in a dose-dependent manner. The safety threshold for donor age in terms of GF should be lowered to 43 years as an early warning for the guarantee of satisfactory outcomes. Clinicians should weigh the benefits against the risks carefully for patients receiving grafts from older donors. Further studies are warranted to investigate the mechanisms responsible for the relationship between donor age and graft quality.
供体年龄会影响肝移植（LT）后同种异体移植物的质量以及受者的预后。临床医生根据老年供体移植物的外观和质地来评估其质量，但缺乏可靠的定量证据。我们的研究旨在基于已发表的文献，评估供体年龄对移植后结局的定量影响及其在肝移植中的安全阈值。从Embase、PubMed和ISI Web of Science数据库中检索相关研究。使用metan计算合并的二分相对风险（RRs）。使用两阶段随机效应模型计算连续RRs。纳入11项研究，共30691例肝移植病例进行进一步分析。在分类比较中，接受老年供体移植物的患者移植后第一年的死亡RR显著更高。同样，移植后3年内移植物失败（GF）的RR也有所增加。在连续比较中，供体年龄的增长以线性方式影响移植结局（>0.05）。供体年龄每增加10岁，90天、180天、1年、3年和5年患者死亡率的RR分别为1.10、1.12、1.15、1.10和1.08，90天、180天、1年、2年和3年GF的RR分别为1.08、1.06、1.10、1.11和1.12（均<0.05）。样条模型显示，使用年龄<43岁供体的移植物进行移植与年龄相关风险无关（>0.05）。在肝移植病例较少、冷缺血时间较长、男性供体较少以及患有病毒性肝炎的受者亚组中，GF风险增加（<0.05）。供体年龄可能以剂量依赖的方式影响肝移植后的结局。就GF而言，供体年龄的安全阈值应降至43岁，作为保证满意结局的早期预警。临床医生应为接受老年供体移植物的患者仔细权衡利弊。有必要进一步研究探讨供体年龄与移植物质量之间关系的机制。
