Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore.
ANZ J Surg. 2022 Jul;92(7-8):1867-1872. doi: 10.1111/ans.17877. Epub 2022 Jul 2.
Evidence for use of graft from older donors in living donor liver transplantation (LDLT) has been conflicting. This study aims to clarify the impact of donor age on recipient morbidity and mortality after adult LDLT.
A total of 90 live liver donors and recipients who underwent primary adult-to-adult LDLT were divided into three groups according to donor age: donors in 20s (D-20s) group, donors in 30s and 40s (D-30s and 40s) group and donors in 50s & 60s (D-50s and 60s) group. Multivariate analyses were conducted to look for independent risk/prognostic factors. Donor age was analysed as a continuous variable to determine an optimal cut off.
Overall donor morbidity was 4/90 (4.44%), major donor morbidity was 1/90 (1.11%) and there was no donor mortality. Recipients in the D-20s group had better 1-, 3- and 5-year recipient survival than recipients in the D-50s and 60s group (96%, 91%, 91% versus 73%, 58%, 58%, respectively) (P = 0.020). Donor age was identified to be an independently significant risk factor for increased major complications (P = 0.007) and prognostic factor for reduced overall survival (P = 0.014). The optimal donor age cut off was determined to be 46.5 years old.
Older donors are associated with poorer recipient outcomes after adult-to-adult LDLT. Usage of liver grafts from older donors should be carefully considered when choosing liver grafts for patients undergoing LDLT.
关于在活体肝移植（LDLT）中使用老年供体移植物的证据存在争议。本研究旨在阐明供者年龄对成人 LDLT 后受者发病率和死亡率的影响。
将 90 例接受成人对成人 LDLT 的活体肝供者和受者分为三组，根据供者年龄：20 岁组（D-20s 组）、30 岁和 40 岁组（D-30s 和 40s 组）和 50 岁及 60 岁组（D-50s 和 60s 组）。进行多变量分析以寻找独立的风险/预后因素。将供者年龄作为连续变量进行分析，以确定最佳截断值。
总体供者发病率为 4/90（4.44%），主要供者发病率为 1/90（1.11%），无供者死亡。D-20s 组的受者 1 年、3 年和 5 年生存率均优于 D-50s 和 60s 组（分别为 96%、91%、91%和 73%、58%、58%）（P=0.020）。供者年龄是导致主要并发症增加的独立危险因素（P=0.007）和总生存时间减少的预后因素（P=0.014）。确定最佳供者年龄截断值为 46.5 岁。
老年供者与成人 LDLT 后受者结局较差相关。在选择 LDLT 患者的肝移植物时，应谨慎考虑使用老年供者的肝移植物。
