背景:在过去,循环系统死亡后,来自老年供体的移植物与肝移植的不良预后相关。但在过去的十年里,它似乎仍然存在争议,由于修改了临床方案,选定的收件人,和先进的器官灌注和保存技术。本研究旨在研究年龄较大的供体对使用循环性死亡(DCD)后捐献的移植物进行肝移植的并发症和存活率的影响。
方法:纳入2015年至2020年接受DCD肝移植的944例患者,分为两组:使用年龄较大的供体(年龄≥65岁,n=87)和年轻的捐赠者(年龄<65岁,n=857)。采用倾向评分匹配(PSM)消除选择偏倚。
结果:在研究期间,观察到肝移植与来自老年供体的移植物的比例从1.68%逐渐增加到15.44%。平衡良好的老年供体(n=79)和年轻供体(n=79)为1:1匹配。老年供体组的胆道非吻合口狭窄(NAS)发作明显多于年轻供体组[15/79(19.0%)与6/79(7.6%);P=0.017。关于早期同种异体移植功能障碍(EAD)和原发性无功能(PNF),差异未达到统计学意义。老年肝脏有向劣质1-的趋势,2-,与年轻肝脏相比,3年移植物和总生存率,但这些差异没有统计学意义(63.1%,57.6%,57.6%与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)。存活不良的唯一危险因素是老年供体组的ABO不相容移植(P=0.008)。在ABO不相容病例的亚组中,它显示了老年供体组和年轻供体组之间NAS的显着差异[6/8(75.0%)与3/14(21.4%);P=0.014]。
结论:与年轻供体相比,循环性死亡后来自老年供体(年龄≥65岁)的移植物的移植更频繁地与较差的结局相关。DCD的较旧移植物更有可能开发NAS,尤其是在ABO不相容的情况下。
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).
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.
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].
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.