Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China.
Int J Surg. 2022 Sep;105:106839. doi: 10.1016/j.ijsu.2022.106839. Epub 2022 Aug 18.
Profound organ shortages worldwide have led to the increased utilization of marginal organs from older individuals. However, the effectiveness of liver transplantation (LT) with organs from elderly donors for patients with hepatocellular carcinoma (HCC) remains controversial. The objective of the current study was to assess the overall survival (OS) and disease-free survival (DFS) of patients with HCC following LT using grafts from deceased donors over 60 years old.
Patients with HCC who underwent LT between 2015 and 2018 were identified in the China Liver Transplant Registry database. The overall survival and disease-free survival of older liver donors (OLDs) were compared with those of younger liver donors (YLDs) after propensity score matching.
From January 2015 to December 2018, a total of 4971 HCC patients were enrolled in the study according to the screening criteria. The absolute and relative utilization of liver grafts from elderly patients over 60 years for HCC patients increased every year, from 65 (9.3%) in 2015 to 268 (14.5%) in 2018. Disease-free survival (DFS) was significantly lower in HCC patients with elderly donors (both P < 0.05) after propensity score matching. The OLD group had worse DFS than YLD group if patients had tumors beyond the Milan criteria (P < 0.05).
The use of older donors for LT has been growing quickly in the last few years in China. Grafts from older donors can be safely used in HCC recipients with similar OS and comparable perioperative complications. However, further investigation into whether older donor has an impact on recurrence is warranted, especially among those with tumors beyond the Milan criteria.
全球范围内供体器官严重短缺，导致越来越多的人开始使用来自高龄个体的边缘供体器官。然而，对于肝细胞癌（HCC）患者，来自老年供体的肝脏移植（LT）的有效性仍然存在争议。本研究旨在评估使用超过 60 岁的已故供体进行 LT 后 HCC 患者的总体生存率（OS）和无病生存率（DFS）。
在中国肝移植注册数据库中，确定了 2015 年至 2018 年期间接受 LT 的 HCC 患者。通过倾向评分匹配，比较了老年供体（OLDs）和年轻供体（YLDs）的总体生存率和无病生存率。
根据筛选标准，从 2015 年 1 月至 2018 年 12 月，共有 4971 名 HCC 患者纳入研究。每年 HCC 患者使用 60 岁以上老年患者的肝脏移植物的绝对和相对数量都在增加，从 2015 年的 65 例（9.3%）增加到 2018 年的 268 例（14.5%）。在倾向评分匹配后，老年供体组 HCC 患者的无病生存率（DFS）明显较低（均 P<0.05）。如果患者肿瘤超过米兰标准，OLD 组的 DFS 明显低于 YLD 组（P<0.05）。
近年来，中国 LT 中使用老年供体的情况迅速增加。来自老年供体的移植物可安全用于 HCC 受者，具有相似的 OS 和可比较的围手术期并发症。然而，需要进一步研究老年供体是否对复发有影响，特别是在米兰标准之外的患者中。
