RESUMEN
BACKGROUND: There are increasingly more patients awaiting liver transplantation while the number of donors has remained stable. It has been proven that grafts from donors older than 60 years have comparable results with those from younger donors. It is unclear whether this is so with donors older than 80 years old. MATERIAL AND METHODS: This was a retrospective study of all adult liver transplantations at our institution between March 2011 and December 2015. We compared 1-, 3-, 6-, and 12-month graft survival rates from donors <80 years and ≥80 years. We also compared postoperative complications: infections, acute kidney injury, need for readmission in the intensive care unit, length of stay, mechanical ventilation, and specific graft complications. We considered differences in each age group regarding the presence of hepatitis C virus (HCV). RESULTS: Of 177 recipients, 38 received grafts from octogenarian donors (21.5%). Survival rates were very similar in the groups (97%, 93%, 91%, and 87% for donors <80 years and 95%, 92%, 87%, and 76% for donors ≥80 years). Although for younger grafts, 1-year survival rates were slightly lower for HCV+ patients (80% vs 89%; log-rank 0.205), this difference does not exist for elderly donors. The incidence of postoperative complications was similar in both groups. CONCLUSIONS: Livers from octogenarian donors are acceptable for liver transplantation provided that thorough assessment and selection is made by avoiding other known poor prognosis factors. The presence of HCV did not affect survival rates.
Asunto(s)
Anciano de 80 o más Años , Selección de Donante/métodos , Trasplante de Hígado/métodos , Complicaciones Posoperatorias/epidemiología , Donantes de Tejidos/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Femenino , Supervivencia de Injerto , Humanos , Incidencia , Trasplante de Hígado/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Morbidity and mortality rates in orthotopic liver transplantation have decreased in the past few years. Risk factors related to severe postoperative complications, such as primary graft dysfunction, still need to be analyzed. We evaluated the influence of the hypnotic agent used during anesthesia on primary graft dysfunction. METHODS: We performed a retrospective analysis of 419 consecutive patients who received a liver transplant between 2005 and 2013 in a single center. We analyzed the incidence of primary graft dysfunction (defined as alanine aminotransferase or aspartate aminotransferase levels higher than 1500 IU/L on the first 3 days after surgery) and if the hypnotic agent was associated with this event. RESULTS: The incidence of primary graft dysfunction was 42.2% (114 patients), similar in both groups (propofol group, 89 patients, 43.2% and sevoflurane group, 25 patients, 39.1%). In the multivariate analysis, we did not find any relationship between the hypnotic agent (propofol or sevoflurane) and early graft dysfunction. CONCLUSIONS: In our patients, we found no differences in the incidence of liver graft dysfunction according to the hypnotic used during transplantation. We can suggest that both drugs (sevoflurane and propofol) are equally safe in orthotopic liver transplantation.