公民逝世后器官捐献老年供肝肝移植短期疗效单中心分析

Short-term outcome of liver transplantation from elderly donor liver of China donation after Citizen’s death:A single-center analysis

目的 探讨老年供肝(≥60岁)对中国公民逝世后器官捐献(CDCD)供肝肝移植的安全性和短期临床疗效的影响。方法 回顾性分析2015年1月1日至2020年9月30日在安徽医科大学第一附属医院器官移植中心接受CDCD来源肝移植手术的95例肝供体及肝受体(患者)的临床资料,排除儿童肝移植、再次肝移植、劈离式肝移植、肝肾联合移植、活体肝移植,最终本研究纳入79例进行分析。肝移植方式采用经典原位或改良背驮式手术方式。根据肝供体年龄将患者分为老年肝供体组(≥60岁,15例)和青年肝供体组(<60岁,64例)。比较两组肝供体的一般资料及患者的围手术期情况。采用电话或门诊方式进行随访,截止至2022年4月30日,比较两组患者肝移植术后生存率差异。结果 老年肝供体组和青年肝供体组的肝供体在性别、BMI、捐献类型、ICU停留时间、术前血清钠、术前ALT及AST、冷缺血及热缺血时间方面比较,差异均无统计学意义(P>0.05)。两组患者在性别、年龄、原发肝病、手术方式、术中出血量与输血量、无肝期、手术时间、ICU停留时间、住院时间、住院费用、Ⅲ类及以上并发症发生率方面比较,差异均无统计学意义(P>0.05)。肝移植后,老年肝供体组患者中位随访时间32个月,肝移植后1、2年生存率分别为86.7%和77.0%;青年肝供体组患者中位随访时间29个月,肝移植后1、2年生存率分别为81.3%和77.8%;两组差异无统计学意义(P>0.05)。结论 经过严格仔细的肝供体评估,老年肝供体可以安全地应用于肝移植手术,而且术后患者能够获得良好的短期生存效果。

Objective To investigate the safety and efficiency of liver transplantation from elderly donor liver(≥60 years)of China Donation after Citizen’s Death(CDCD).Methods This retrospective study included 95 pairs of donors and respective recipients(patients)who underwent liver transplantation from CDCD,in the First Affiliated Hospital of Anhui Medical University from Jan.1,2015 to Sep.30,2020.After the exclusion of pediatric liver transplantation,re-transplantation,split liver transplantation,combined liver-kidney transplantation,and living donor liver transplantation,79 pairs of donors and respective recipients(patients)were included for further analysis.The recipients were performed with classic orthotopic or modified piggyback liver transplantation,and were divided into the elderly donor group(≥60 years,n=15)and the young donor group(<60 years,n=64).Follow-up was underwent by telephone and outpatient clinic records,the deadline for follow-up was Apr.30,2022.The patients survival rates between two groups were compared.Results For donors analysis,there was no statistical differences in gender,body mass index(BMI),donation type,ICU stay time,preoperative serum sodium level,preoperative serum alanine aminotransferase and aspartate transaminase levels,cold and warm ischemia time between the two groups(P>0.05).For recipients(patients)analysis,there was no statistical difference in gender,age,primary liver disease,surgical procedure,intraoperative bleeding and transfusion,anhepatic phase duration,operative time,ICU stay time,hospitalization time,hospitalization expense,incidence of Clavien-Dindo gradeⅢor above between the two groups(P>0.05).The median time of follow-up was 32 months in the elderly donor group and 29 months in the young donor group.The postoperative 1-year and 2-year survival rates in the elderly donor group were 86.7%and 77.0%,respectively,which were not statistically different from 81.3%and 77.8%in the young donor group(P>0.05).Conclusion This sing-center study shows that,under the premise of rigorous evaluation,elderly donors can be used safely in liver transplantation,and patients may achieve favorable short-term postoperative survival outcome.