文章：

高龄供体（≥85岁）肝脏移植

Liver Transplantation from Elderly Donors (≥85 Years Old)

原文发布日期：8 May 2024

DOI: 10.3390/cancers16101803

类型: Article

开放获取: 是

英文摘要：

Background: Despite the ongoing trend of increasing donor ages in liver transplantation (LT) setting, a notable gap persists in the availability of comprehensive guidelines for the utilization of organs from elderly donors. This study aimed to evaluate the viability of livers grafts from donors aged ≥85 years and report the post-LT outcomes compared with those from “ideal” donors under 40 years old. Methods: Conducted retrospectively at a single center from 2005 to 2023, this study compared outcomes of LTs from donors aged ≥85 y/o and ≤40 y/o, with the propensity score matching to the recipient’s gender, age, BMI, MELD score, redo-LT, LT indication, and cause of donor death. Results: A total of 76 patients received grafts from donors ≥85 y/o and were compared to 349 liver grafts from donors ≤40 y/o. Prior to PSM, the 5-year overall survival was 63% for the elderly group and 77% for the young group (p= 0.002). After PSM, the 5-year overall survival was 63% and 73% (p= 0.1). A nomogram, developed at the time of graft acceptance and including HCC features, predicted 10-year survival after LT using a graft from a donor aged ≥85. Conclusions: In the context of organ scarcity, elderly donors emerge as a partial solution. Nonetheless, without proper selection, LT using very elderly donors yields inferior long-term outcomes compared to transplantation from very young donors ≤40 y/o. The resulting nomogram based on pre-transplant criteria allows for the optimization of elderly donor/recipient matching to achieve satisfactory long-term results, in addition to traditional matching methods.

摘要翻译： 

背景：尽管肝移植领域供体年龄增长趋势持续，但针对高龄供体器官使用的综合指南仍存在显著空白。本研究旨在评估≥85岁供体肝移植物的可行性，并与40岁以下"理想"供体的移植后结果进行比较。方法：本研究为2005年至2023年单中心回顾性研究，通过倾向评分匹配法平衡受者性别、年龄、BMI、MELD评分、再次移植、移植适应症及供体死亡原因等变量，比较≥85岁与≤40岁供体的肝移植结局。结果：共76例患者接受≥85岁供体移植物，与349例≤40岁供体肝移植进行对比。倾向评分匹配前，高龄组5年总生存率为63%，年轻组为77%（p=0.002）；匹配后两组分别为63%与73%（p=0.1）。研究构建的列线图整合移植物接受时的肝细胞癌特征，可预测使用≥85岁供体肝移植后的10年生存率。结论：在器官短缺背景下，高龄供体可作为部分解决方案。但若缺乏适当筛选，使用超高龄供体的肝移植长期效果仍显著低于≤40岁年轻供体。基于移植前标准构建的列线图，结合传统匹配方法，可优化高龄供体-受体匹配，从而获得满意的长期移植效果。

原文链接：

Liver Transplantation from Elderly Donors (≥85 Years Old)