Abstract: Objective: To explore the clinical efficacy of liver transplantation using aged liver grafts from donation after citizen′s death (DCD).
Methods:The retrospective casecontrol study was adopted. The clinicopathological data of 146 patients who underwent liver transplatation using liver grafts from DCD at the Tongji Hospital of Huazhong University of Science and Technology from January 2011 to December 2015 were collected. Of 146 patients, fortysix recipients who received liver grafts from donors≥60 years were allocated into the donor age≥60 years group and 100 who received liver grafts from donor age<60 years were allocated into the donor age<60 years group. Observed indicators included: (1) the incidence of primary liver graft nonfunction (PNF) and initial poor function (IPF) of transplanted liver, (2) liver function recovery in the first postoperative month, (3) the postoperative complications, including reoperation because of bleeding, acute rejection, thrombosis of hepatic artery, thrombosis of portal vein, biliary complications, neurological complications, bacterial infection, cytomegalovirus infection and adverse reaction of calcineurin inhibitors, (4) postoperative survival rate in liver transplant recipients. The regular followup using outpatient examination was performed to detect indexes of laboratory examination and postoperative complications and survival of patients till January 2016. Measurement data with normal distribution were represented as ±s and comparison between groups was evaluated with the independent t test. Measurement data with skewed distribution were represented as M(Qn) and analyzed by MannWhitney test. Count data were analyzed using the chisquare test.
Results:(1) The incidences of PNF and IPF of transplanted liver: two patients in the donor age≥60 years group and 1 patient in the donor age<60 years group had PNF, with no significant difference between two groups (χ²=1.754, P>0.05). Eight patients in the donor age≥60 years group and 6 patients in the donor age<60 years group had IPF, with a significant difference between the 2 groups (χ²=4.716, P<0.05). (2) Liver function recovery in the first postoperative month: the alanine aminotransferase level was (251±45)U/L and (56±38)U/L in the donor age≥60 years group and <60 years group in the first postoperative week, respectively, showing a significant difference between the 2 groups (t=26.980, P<0.05). Serum total bilirubin (TBil) level was (48±12)μmol/L and (13±6)μmol/L in the donor age≥60 years group and <60 years group in the postoperative 14 days, respectively, showing a significant difference (t=22.790, P<0.05). (3) The postoperative complications: the number of patients with reoperation because of bleeding, acute rejection, thrombosis of hepatic artery, thrombosis of portal vein, biliary complications, neurological complications, bacterial infection and cytomegalovirus infection was 0, 3, 0, 1, 4, 3, 7, 1 in the donor age≥60 years group and 2, 6, 1, 2, 7, 6, 16, 3 in the donor age<60 years group, respectively, showing no significant difference between the 2 groups (χ²=0.933, 0.000, 0.463, 0.001, 0.130, 0.000, 0.015, 0.081, P>0.05). Nine patients had adverse reaction of calcineurin inhibitors in the donor age≥60 years group and 6 patients in the donor age<60 years group, showing a significant difference (χ²=1.904, P<0.05). (4) Postoperative survival in liver transplant recipients: the survival rate of 1 month after transplantation was 91.30%(42/46) and 99.00% (99/100) in the donor age≥60 years group and <60 years group, respectively, with a significant difference (χ²=5.642, P<0.05). However, the 1year survival rate after transplantation was 89.13%(41/46) and 95.00%(95/100) in the donor age≥60 years group and <60 years group, respectively, with no significant difference (χ²=1.701, P>0.05).
Conclusion: Using liver grafts from donor age≥60 years after strict selection can achieve good therapeutic effects in liver transplantation.