Hakeem Abdul Rahman, Fathima Rukhaiya, Padmanaban Hrishikesh, Haribabu Kulaseharan, Rajalingam Rajesh, Palaniappan Kumar, Jothimani Dinesh, Kanagavelu Rathan, Rajakumar Akila, Kaliamoorthy Ilankumaran, Reddy Mettu Srinivas, Rela Mohamed
The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India.
Liver Transpl. 2021 Sep;27(9):1273-1282. doi: 10.1002/lt.26061. Epub 2021 Jul 21.
The impact of increasing recipient age on morbidity and mortality following living donor liver transplantation (LDLT) remains controversial. The study aims to analyze the impact of recipient age on outcomes following LDLT. Data on adult LDLTs performed between November 2009 and February 2020 were retrieved from a prospectively maintained database. Patients were stratified into 2 groups based on recipient age: 18 to 65 years (younger adults) and >65 years (older adults). Propensity score matching (PSM) using nearest-neighbor matching was used to match each older recipient with up to 2 younger adult recipients using multiple preoperative parameters. Outcomes evaluated were duration of ventilation, need for reintubation, tracheostomy, intensive care unit (ICU) readmission, length of ICU and hospital stays, postoperative complications, reoperation within 90 days, and patient survival. A total of 801 adult LDLT recipients were included in the study; 751 (93.7%) were younger adults, and 50 (6.3%) were older adults. Older recipients were more likely to be diabetic (60.0% versus 39.7%) and hypertensive (44.0% versus 20.4%) with preexisting cardiac disease (28.0% versus 11.2%). However, their pretransplant Model for End-Stage Liver Disease score was significantly lower (14.5 versus 17.7), and they were more likely to receive a transplant because of hepatocellular carcinoma (38.0% versus 17.7%). Older recipients had longer durations of ventilation after LT both before (3.7 versus 1.9 days) and after PSM (4.0 versus 1.5 days). After PSM, the 30-day (13.0% versus 2.4%), 90-day (15.2% and 2.4%), and overall mortality rates (21.7% versus 7.1%) were significantly higher for older recipients when compared with younger recipients. There was no difference between the younger and older recipients with respect to other postoperative outcomes. This propensity score-matched study shows that the older LDLT recipients have higher 30-day, 90-day, 1-year, and 5-year mortality rates when compared with matched younger counterparts.
受体年龄增加对活体肝移植（LDLT）后发病率和死亡率的影响仍存在争议。本研究旨在分析受体年龄对LDLT术后结局的影响。从一个前瞻性维护的数据库中检索了2009年11月至2020年2月期间进行的成人LDLT数据。根据受体年龄将患者分为两组：18至65岁（年轻成年人）和>65岁（老年成年人）。使用最近邻匹配的倾向评分匹配（PSM）方法，利用多个术前参数将每个老年受体与最多2名年轻成年受体进行匹配。评估的结局包括通气时间、再次插管需求、气管切开术、重症监护病房（ICU）再入院、ICU和住院时间、术后并发症、90天内再次手术以及患者生存率。本研究共纳入801例成人LDLT受体；751例（93.7%）为年轻成年人，50例（6.3%）为老年成年人。老年受体更易患糖尿病（60.0%对39.7%）和高血压（44.0%对20.4%），且存在心脏病（28.0%对11.2%）。然而，他们移植前的终末期肝病模型评分显著更低（14.5对17.7），且因肝细胞癌接受移植的可能性更大（38.0%对17.7%）。老年受体LT术后通气时间在PSM前（3.7天对1.9天）和PSM后（4.0天对1.5天）均更长。PSM后，老年受体的30天（13.0%对2.4%）、90天（15.2%对2.4%）和总体死亡率（21.7%对7.1%）显著高于年轻受体。年轻和老年受体在其他术后结局方面无差异。这项倾向评分匹配研究表明，与匹配的年轻受体相比，老年LDLT受体的30天、90天、1年和5年死亡率更高。
