Jimenez-Romero Carlos, Justo-Alonso Iago, Del Pozo-Elso Pilar, Marcacuzco-Quinto Alberto, Martín-Arriscado-Arroba Cristina, Manrique-Municio Alejandro, Calvo-Pulido Jorge, García-Sesma Alvaro, San Román Ricardo, Caso-Maestro Oscar
Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain.
Clinical Research Unit (I+12), `12 de Octubre´ University Hospital, Madrid 28041, Spain.
World J Gastrointest Surg. 2023 Aug 27;15(8):1615-1628. doi: 10.4240/wjgs.v15.i8.1615.
The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.
To determine the incidence, outcomes, and risk factors for biliary complications (BC) in liver transplantation (LT) using liver grafts from donors aged > 70 years.
Between January 1994 and December 31, 2019, 297 LTs were performed using donors older than 70 years. After excluding 47 LT for several reasons, we divided 250 LTs into two groups, namely post-LT BC ( = 21) and without BC ( = 229). This retrospective case-control study compared both groups.
Choledocho-choledochostomy without T-tube was the most frequent technique (76.2% in the BC group 92.6% in the non-BC group). Twenty-one patients (8.4%) developed BC (13 anastomotic strictures, 7 biliary leakages, and 1 non-anastomotic biliary stricture). Nine patients underwent percutaneous balloon dilation and nine required a Roux-en-Y hepaticojejunostomy because of dilation failure. The incidence of post-LT complications (graft dysfunction, rejection, renal failure, and non-BC reoperations) was similar in both groups. There were no significant differences in the patient and graft survival between the groups. Moreover, only three deaths were attributed to BC. While female donors were protective factors for BC, donor cardiac arrest was a risk factor.
The incidence of BC was relatively low on using liver grafts > 70 years. It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy, without significant differences in the patient or graft survival between the groups.
肝移植供体短缺以及随之而来的等待名单上的死亡率促使我们使用老年供体的肝脏移植来扩大供体库。
确定使用年龄大于70岁供体的肝脏进行肝移植（LT）时胆道并发症（BC）的发生率、结局及危险因素。
在1994年1月至2019年12月31日期间，使用70岁以上供体进行了297例肝移植。因多种原因排除47例肝移植后，我们将250例肝移植分为两组，即肝移植后发生BC组（n = 21）和未发生BC组（n = 229）。这项回顾性病例对照研究对两组进行了比较。
不放置T管的胆总管-胆总管吻合术是最常用的技术（BC组为76.2%，非BC组为92.6%）。21例患者（8.4%）发生了BC（13例吻合口狭窄、7例胆漏和1例非吻合口胆管狭窄）。9例患者接受了经皮球囊扩张，9例因扩张失败需要行Roux-en-Y肝空肠吻合术。两组肝移植后并发症（移植物功能障碍、排斥反应、肾衰竭和非BC再次手术）的发生率相似。两组患者和移植物的生存率无显著差异。此外，仅有3例死亡归因于BC。女性供体是BC的保护因素，而供体心脏骤停是危险因素。
使用70岁以上供体的肝脏时BC的发生率相对较低。大多数情况下可通过经皮扩张或Roux-en-Y肝空肠吻合术进行处理，两组患者或移植物的生存率无显著差异。
