Justo Iago, Marcacuzco Alberto, García-Conde María, Caso Oscar, Cobo Cristina, Nutu Anisa, Manrique Alejandro, Calvo Jorge, García-Sesma Alvaro, Rivas Cristina, Loinaz Carmelo, Jiménez-Romero Carlos
Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain.
Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain.
Transplant Proc. 2022 Sep;54(7):1839-1846. doi: 10.1016/j.transproceed.2022.05.037. Epub 2022 Jul 29.
An increased number of older recipients underwent liver transplantation in recent years, and consequently needing to obtain more liver grafts. In order to increase this pool, in 2006, we initiated the use of livers from uncontrolled circulatory death (uDCD). We analyzed the use of uDCD livers in sexagenarian recipients and their effect on overall survival.
A retrospective and comparative study was performed among 4 groups according to recipient age (less or greater than 60 years) and donor type (donor brain death [DBD] or uDCD): Group A: DBD livers in recipients aged <60 years (n = 169); Group B: uDCD livers in recipients aged <60 years (n = 36); Group C: DBD livers in recipients aged >60 years (n = 96); and Group D: uDCD livers in recipients aged >60 years(n = 39).
Intraoperative transfusion, biliary complications, primary non-function, acute rejection, chronic renal dysfunction, retransplantation, and mortality during follow-up (cardiovascular diseases in 3 patients, hepatitis C virus recurrence in 4 patients, and de novo malignancies in 3 patients) were significantly higher, and 5-year patient and graft survival was significantly lower in sexagenarian recipients. Bilirubin and packed red blood cells transfusion were risk factors for patient survival, whereas hepatocelular carcinoma, creatinine, and packed red blood cells transfusion were risk factors for patient survival. Recipient age (<60 years) was confirmed as protective factor for patient and graft survival, whereas the use of uDCD was not a risk factor for patient or graft survival.
Use of a uDCD liver did not demonstrate as a risk factor for patient and graft survival, and recipient age (<60 years) was a protective factor for patient and graft survival.
近年来，接受肝移植的老年受者数量有所增加，因此需要获取更多的肝移植供体。为了扩大供体库，2006年我们开始使用非控制性循环死亡（uDCD）供肝。我们分析了uDCD供肝在老年受者中的使用情况及其对总体生存的影响。
根据受者年龄（小于或大于60岁）和供体类型（脑死亡供体[DBD]或uDCD）将4组患者纳入回顾性比较研究：A组：年龄<60岁的受者接受DBD供肝（n = 169）；B组：年龄<60岁的受者接受uDCD供肝（n = 36）；C组：年龄>60岁的受者接受DBD供肝（n = 96）；D组：年龄>60岁的受者接受uDCD供肝（n = 39）。
术中输血、胆道并发症、原发性无功能、急性排斥反应、慢性肾功能不全、再次移植以及随访期间的死亡率（3例死于心血管疾病，4例丙型肝炎病毒复发，3例新发恶性肿瘤）在老年受者中显著更高，60岁左右的受者5年患者和移植物生存率显著更低。胆红素和浓缩红细胞输血是患者生存的危险因素，而肝细胞癌、肌酐和浓缩红细胞输血是患者生存的危险因素。受者年龄（<60岁）被确认为患者和移植物生存的保护因素，而使用uDCD供肝不是患者或移植物生存的危险因素。
使用uDCD供肝并未显示为患者和移植物生存的危险因素，受者年龄（<60岁）是患者和移植物生存的保护因素。
