Toshima Takeo, Itoh Shinji, Nagao Yoshihiro, Yoshiya Shohei, Bekki Yuki, Izumi Takuma, Iseda Norifumi, Tsutsui Yuriko, Toshida Katsuya, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
Ann Gastroenterol Surg. 2024 Jan 12;8(4):668-680. doi: 10.1002/ags3.12769. eCollection 2024 Jul.
There is limited evidence regarding the feasibility of living-donor liver transplantation (LDLT) for patients aged over 70. The aims of this study were to assess postoperative outcomes in elderly recipients and to ascertain the potential feasibility and acceptability of LDLT.
Data were collected from 762 recipients, including 26 in the elderly group (aged ≥70) and 736 in the younger group (aged <70), and reviewed even by propensity score matching (PSM).
No significant differences were observed in the frequency of postoperative complications between the two groups. Additionally, both groups exhibited a comparable 30-day mortality rate after LDLT (3.9% in both) and similar hospital stays (36 days vs. 40 days). The 1-, 3-, and 5-year graft survival rates in the elderly group were 92.0%, which was comparable to those in the younger group ( = 0.517), as confirmed by PSM. Notably, all donors for elderly patients were the children of the recipients, with an average age of 41.6 years, and grafts from donors aged ≥50 years were not utilized, signifying the use of high-quality grafts. Our inclusion criterion for elderly recipients was strictly defined as an ECOG-PS score of 0-2, which played a pivotal role in achieving favorable postoperative outcomes.
LDLT can be performed safely for elderly patients aged 70 years or older, provided they have a preserved PS and receive high-quality grafts from younger donors, inevitably all children of elderly recipients. This approach yields acceptable long-term outcomes. Consequently, age alone should not serve as an absolute contraindication for LDLT.
关于70岁以上患者活体肝移植（LDLT）的可行性证据有限。本研究的目的是评估老年受者的术后结局，并确定LDLT的潜在可行性和可接受性。
收集了762例受者的数据，其中老年组（年龄≥70岁）26例，年轻组（年龄<70岁）736例，并通过倾向评分匹配（PSM）进行分析。
两组术后并发症发生率无显著差异。此外，两组LDLT术后30天死亡率相当（均为3.9%），住院时间相似（36天对40天）。经PSM证实，老年组1年、3年和5年移植存活率为92.0%，与年轻组相当（P=0.517）。值得注意的是，所有老年患者的供者均为受者的子女，平均年龄41.6岁，未使用年龄≥50岁供者的移植物，这表明使用了高质量的移植物。我们对老年受者的纳入标准严格定义为东部肿瘤协作组体能状态（ECOG-PS）评分为0-2分，这对实现良好的术后结局起关键作用。
对于70岁及以上的老年患者，只要其体能状态良好，并接受来自年轻供者（必然是老年受者的子女）的高质量移植物，LDLT可以安全进行。这种方法可产生可接受的长期结局。因此，年龄本身不应作为LDLT的绝对禁忌证。
