Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Transplantation. 2024 Jul 1;108(7):e110-e120. doi: 10.1097/TP.0000000000004865. Epub 2023 Nov 22.
With the chronic shortage of donated organs, expanding the indications for liver transplantation (LT) from older donors is critical. Nonalcoholic steatohepatitis (NASH) stands out because of its unique systemic pathogenesis and high recurrence rate, both of which might make donor selection less decisive. The present study aims to investigate the usefulness of old donors in LT for NASH patients.
The retrospective cohort study was conducted using the Scientific Registry Transplant Recipient database. The cohort was divided into 3 categories according to donor age: young (aged 16-35), middle-aged (36-59), and old donors (60-). Multivariable and Kaplan-Meier analyses were performed to compare the risk of donor age on graft survival (GS).
A total of 67 973 primary adult donation-after-brain-death LTs (2002-2016) were eligible for analysis. The multivariable analysis showed a reduced impact of donor age on GS for the NASH cohort (adjusted hazard ratio = 1.13, 95% confidence interval, 1.00-1.27), comparing old to middle-aged donors. If the cohort was limited to NASH recipients plus 1 of the following, recipient age ≥60, body mass index <30, or Model of End Stage Liver Disease score <30, adjusted hazard ratios were even smaller (0.99 [0.84-1.15], 0.92 [0.75-1.13], or 1.04 [0.91-1.19], respectively). Kaplan-Meier analysis revealed no significant differences in overall GS between old- and middle-aged donors in these subgroups ( P = 0.86, 0.28, and 0.11, respectively).
Donor age was less influential for overall GS in NASH cohort. Remarkably, old donors were equivalent to middle-aged donors in subgroups of recipient age ≥60, recipient body mass index <30, or Model of End Stage Liver Disease score <30.
由于捐赠器官长期短缺，扩大肝移植（LT）的适应证范围至关重要。非酒精性脂肪性肝炎（NASH）因其独特的全身发病机制和高复发率而引人注目，这两者可能使供体选择不那么果断。本研究旨在探讨老年供体在 NASH 患者 LT 中的应用价值。
本回顾性队列研究使用科学注册处移植受者数据库进行。该队列根据供体年龄分为 3 类：年轻（16-35 岁）、中年（36-59 岁）和老年（60-）。多变量和 Kaplan-Meier 分析用于比较供体年龄对移植物存活率（GS）的风险。
共有 67973 例成人脑死亡后首次 LT（2002-2016 年）符合分析条件。多变量分析显示，NASH 组供体年龄对 GS 的影响降低（调整后的危险比=1.13，95%置信区间，1.00-1.27），与中年供体相比，老年供体的影响更小。如果将队列限制为 NASH 受者加上以下 1 项，即受者年龄≥60 岁、体质量指数（BMI）<30 或终末期肝病模型（MELD）评分<30，调整后的危险比甚至更小（0.99[0.84-1.15]、0.92[0.75-1.13]或 1.04[0.91-1.19]）。Kaplan-Meier 分析显示，在这些亚组中，老年供体与中年供体之间的总 GS 无显著差异（P=0.86、0.28 和 0.11）。
供体年龄对 NASH 组的总体 GS 影响较小。值得注意的是，在受者年龄≥60 岁、受者 BMI<30 或 MELD 评分<30 亚组中，老年供体与中年供体等效。
