Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

作     者：Oscar Caso-Maestro Carlos Jiménez-Romero Iago Justo-Alonso Jorge Calvo-Pulido David Lora-Pablos Alberto Marcacuzco-Quinto Félix Cambra-Molero Alvaro García-Sesma Marina Pérez-Flecha Carlos Munoz- Arce Carmelo Loinaz-Segurola Alejandro Manrique-Municio 

作者机构：Unit of HBP Surgery and Abdominal Organs TransplantationDepartment of General Surgery“12 de octubre” University HospitalMadrid 28041Spain Clinical Research DepartmentConsortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)“12 de octubre” University HospitalMadrid 28041Spain 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2018年第24卷第47期

页      面：5391-5402页

核心收录：

学科分类：10[医学] 

主　　题：Liver transplantation Aged donors Old donors Marginal donors Donor age 

摘      要：AIM To increase the number of available *** This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with donors ≥ 70 years old(study group). Then, we selected the first cases that were performed with donors 70 years old immediately after the ones that were performed with donors ≥ 70 years old(control group).RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus(HCV)-positivity [hazard ratio(HR) = 2.35; 95% confidence interval(CI): 1.55-3.56; P = 0.00]; recipient age(HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease(D-MELD)(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium(HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD(donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients(77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.