Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Division of Transplant Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
Transplantation. 2023 Jan 1;107(1):162-171. doi: 10.1097/TP.0000000000004289. Epub 2022 Aug 31.
The impact of selecting older donors for living donor liver transplantation (LDLT) in the United States is incompletely studied, particularly in light of the recent expansion of LDLT nationally.
Adult LDLTs from January 01, 2005 to December 31, 2019 were identified using the United Network for Organ Sharing database. Multivariable Cox models evaluated living donor (LD) age as a predictor of LDLT recipient and graft survival. The impact of increasing donor age on recipient outcomes was compared between LD and deceased donor recipients. Donor postoperative outcomes were evaluated.
There were 3539 LDLTs at 65 transplant centers during the study period. Despite the recent expansion of LDLT, the proportion of LDs aged ≥50 y was stable. There were no clinically significant differences in recipient or donor characteristics by LD age group. LD age ≥50 y was associated with an adjusted hazard ratio of 1.49 ( P = 0.012) for recipient survival and 1.61 ( P < 0.001) for graft survival (vs LDs aged 18-29 y). The negative impact of increasing donor age on graft survival was more profound after LDLT than deceased donor liver transplantation (interaction P = 0.019). There was a possible increased rate of early donor biliary complications for donors >55 y (7.1% versus 3.1% for age <40 y; P = 0.156).
Increasing LD age is associated with decreased recipient and graft survival, although older donors still largely yield acceptable outcomes. Donor outcomes were not clearly impacted by increasing age, though this warrants further study.
在美国，选择老年供体进行活体肝移植（LDLT）的影响尚未得到充分研究，尤其是考虑到 LDLT 在全国范围内的最近扩张。
使用美国器官共享网络数据库确定 2005 年 1 月 1 日至 2019 年 12 月 31 日期间的成人 LDLT。多变量 Cox 模型评估活体供体（LD）年龄作为 LDLT 受者和移植物存活的预测因子。比较 LD 和已故供体受者之间增加供体年龄对受者结局的影响。评估供体术后结局。
在研究期间，有 3539 例 LDLT 在 65 个移植中心进行。尽管 LDLT 最近有所扩张，但≥50 岁 LD 的比例保持稳定。LD 年龄组之间的受者或供者特征没有临床显著差异。LD 年龄≥50 岁与调整后的受者存活率风险比 1.49（P=0.012）和移植物存活率风险比 1.61（P<0.001）相关（与 18-29 岁 LD 相比）。在 LDLT 后，增加供体年龄对移植物存活率的负面影响比已故供体肝移植更严重（交互 P=0.019）。年龄>55 岁的供体早期胆并发症发生率可能增加（7.1%与年龄<40 岁时的 3.1%相比；P=0.156）。
LD 年龄的增加与受者和移植物存活率降低相关，但老年供体仍主要产生可接受的结果。供体结局并未明显受到年龄增加的影响，但这需要进一步研究。
