来自心跳停止后捐献的老年供肝与存活率降低和非吻合胆道狭窄发生率升高有关。

Older liver grafts from donation after circulatory death are associated with impaired survival and higher incidence of biliary non-anastomotic stricture.

机构信息

Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310022, China.

Division of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2023 Dec;22(6):577-583. doi: 10.1016/j.hbpd.2023.01.010. Epub 2023 Feb 2.

DOI:10.1016/j.hbpd.2023.01.010

PMID:36775686

Abstract

BACKGROUND

Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past. But it has seemed to remain controversial in the last decade, as a result of modified clinical protocols, selected recipients, and advanced technology of organ perfusion and preservation. The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death (DCD).

METHODS

A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups: using graft from older donor (aged ≥ 65 years, n = 87) and younger donor (age < 65 years, n = 857). Propensity score matching (PSM) was applied to eliminate selection bias.

RESULTS

A progressively increased proportion of liver transplants with grafts from older donors was observed from 1.68% to 15.44% during the study period. The well-balanced older donor (n = 79) and younger donor (n = 79) were 1:1 matched. There were significantly more episodes of biliary non-anastomotic stricture (NAS) in the older donor group than the younger donor group [15/79 (19.0%) vs. 6/79 (7.6%); P = 0.017]. The difference did not reach statistical significance regarding early allograft dysfunction (EAD) and primary non-function (PNF). Older livers had a trend toward inferior 1-, 2-, 3-year graft and overall survival compared with younger livers, but these differences were not statistically significant (63.1%, 57.6%, 57.6% vs. 76.9%, 70.2%, 67.7%, P = 0.112; 64.4%, 58.6%, 58.6% vs. 76.9%, 72.2%, 72.2%, P = 0.064). The only risk factor for poor survival was ABO incompatible transplant (P = 0.008) in the older donor group. In the subgroup of ABO incompatible cases, it demonstrated a significant difference in the rate of NAS between the older donor group and the younger donor group [6/8 (75.0%) vs. 3/14 (21.4%); P = 0.014].

CONCLUSIONS

Transplants with grafts from older donors (aged ≥ 65 years) after circulatory death are more frequently associated with inferior outcome compared to those from younger donors. Older grafts from DCD are more likely to develop NAS, especially in ABO incompatible cases.

摘要

背景

在过去的肝移植中，来自循环死亡后供体的移植物与较差的结果相关。但在过去十年中，由于临床方案的修改、选择的受者以及器官灌注和保存的先进技术，这种情况似乎仍然存在争议。本研究旨在检查使用循环死亡后捐赠（DCD）供体的移植物对肝移植并发症和存活率的影响。

方法

共纳入 2015 年至 2020 年接受 DCD 肝移植的 944 例患者，并分为两组：使用年龄≥65 岁的供体（n=87）和年龄<65 岁的供体（n=857）的移植物。应用倾向评分匹配（PSM）消除选择偏倚。

结果

研究期间，来自老年供体（年龄≥65 岁）的肝移植比例从 1.68%逐渐增加到 15.44%。在 1:1 匹配的情况下，老年供体（n=79）和年轻供体（n=79）情况良好。老年供体组发生胆肠吻合口非狭窄（NAS）的比例明显高于年轻供体组[15/79（19.0%）vs.6/79（7.6%）；P=0.017]。在早期移植物功能障碍（EAD）和原发性无功能（PNF）方面，差异无统计学意义。与年轻供体相比，老年供体的 1 年、2 年和 3 年移植物和总体存活率呈下降趋势，但差异无统计学意义（63.1%、57.6%、57.6%vs.76.9%、70.2%、67.7%，P=0.112；64.4%、58.6%、58.6%vs.76.9%、72.2%、72.2%，P=0.064）。老年供体组中，唯一影响生存的危险因素是 ABO 不相容移植（P=0.008）。在 ABO 不相容的亚组中，老年供体组与年轻供体组之间 NAS 的发生率存在显著差异[6/8（75.0%）vs.3/14（21.4%）；P=0.014]。