RESUMO
Recently, there has been a large discrepancy between the number of patients on the waiting list for a liver transplant and the availability of deceased donors, with an increase in annual wait list mortality rates. Elderly donor livers are thought to be marginal grafts; however, in recent years, their utilization has constantly increased. The aim of this study is to evaluate the utilization of elderly donors in Andalusia and post-transplant outcomes. This retrospective observational study of 2408 liver transplants, performed in Andalusia between 2000 and 2014, analyzes the outcomes from donors aged 70 plus (n = 423) in terms of survival rates of the graft and the recipient, the type of transplant, donor age, and D-MELD score (product of donor age and preoperative Model for End-stage Liver Disease score). The most frequent indications for transplant were alcoholic cirrhosis (49.2%), hepatitis C cirrhosis (13%), and hepatocellular carcinoma (12.5%). The overall survival at 5 years was 64%, with a significant fall in survival for recipients with a D-MELD greater than 1500 (57%; P = .045). In the 70-year-old-plus donor group, the overall patient survival was 58.4%. The retransplant rate increased proportionately with donor age. In the alcoholic cirrhosis recipient subgroup, the overall survival at 5 years was 67.6% (P < .05) compared with 33.5% in patients with hepatitis C. Use of elderly donors is a safe strategy to reduce the scarcity of donors, provided that a D-MELD score below 1500 is obtained. Retransplant rates increase progressively with donor age. It is necessary to carefully screen recipients of older organs, taking into account that the best results are obtained for alcoholic cirrhosis, negative viral load hepatitis C, and a D-MELD score below 1500.
Assuntos
Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/cirurgia , Transplante de Fígado/mortalidade , Doadores de Tecidos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Doença Hepática Terminal/patologia , Feminino , Sobrevivência de Enxerto , Hepatite C/complicações , Hepatite C/mortalidade , Humanos , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/mortalidade , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Espanha , Análise de Sobrevida , Taxa de Sobrevida , Listas de EsperaAssuntos
Neoplasias do Colo/complicações , Hemorragia Gastrointestinal/etiologia , Lipoma/complicações , Reto , Idoso , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Colonoscopia , Humanos , Lipoma/diagnóstico , Lipoma/patologia , Lipoma/cirurgia , Masculino , Úlcera/etiologiaAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico , Hemorragia Gastrointestinal/etiologia , Lipoma/complicações , Lipoma/diagnóstico , Reto/patologia , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Colonoscopia , Lipoma/patologia , Lipoma/cirurgiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Tumores do Estroma Endometrial , Neoplasias Retais , Tumores do Estroma Endometrial/diagnóstico , Tumores do Estroma Endometrial/cirurgia , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgiaRESUMO
Se presenta un caso de traumatismo hepático muy severo que motivó la hepatectomía total y el trasplante hepático varias horas después, determinando una duración prolongada de la fase anhepática. La evolución posterior fue desfavorable falleciendo finalmente el paciente. Sometemos a consideración la indicación de hepatectomía más trasplante en el traumatismo hepático severo y cómo influye en la evolución posterior una fase anhepática prolongada (AU)
