Octogenarian Donors in Liver Transplantation (original) (raw)
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Octogenarian liver grafts: Is their use for transplant currently justified?
World journal of gastroenterology, 2017
To analyse the impact of octogenarian donors in liver transplantation. We present a retrospective single-center study, performed between November 1996 and March 2015, that comprises a sample of 153 liver transplants. Recipients were divided into two groups according to liver donor age: recipients of donors ≤ 65 years (group A; n = 102), and recipients of donors ≥ 80 years (group B; n = 51). A comparative analysis between the groups was performed. Quantitative variables were expressed as mean values and SD, and qualitative variables as percentages. Differences in properties between qualitative variables were assessed by χ(2) test. Comparison of quantitative variables was made by t-test. Graft and patient survivals were estimated using the Kaplan-Meier method. One, 3 and 5-year overall patient survival was 87.3%, 84% and 75.2%, respectively, in recipients of younger grafts vs 88.2%, 84.1% and 66.4%, respectively, in recipients of octogenarian grafts (P = 0.748). One, 3 and 5-year over...
Liver transplantations with donors aged 60 years and above: the low liver damage strategy
Transplant International, 2009
According to transplant registries, grafts from elderly donors have lower survival rates. During 1999–2005, we evaluated the outcomes of 89 patients who received a liver from a donor aged ≥ 60 years and managed with the low liver-damage strategy (LLDS), based on the preoperative donor liver biopsy and the shortest possible ischemia time (group D ≥ 60-LLDS). Group D ≥ 60-LLDS was compared with 198 matched recipients, whose grafts were not managed with this strategy (89 donors < 60 years, group D < 60-no-LLDS and 89 donors aged ≥60 years, group D ≥ 60-no-LLDS). In the donors proposed from the age group of ≥60 years, the number of donors rejected decreased during the study period and the LLDS was found to be responsible for this in a significant manner (47% vs. 60%, respectively P < 0.01). Among the recipients transplanted, the clinical features (age, gender, viral infection, child and model for end-stage liver disease score) were comparable among groups, but group D ≥ 60-LLDS had a lower mean ischemia time: 415 ± 106 min vs. 465 ± 111 (D < 60-no-LLDS), P < 0.05 and vs. 476 ± 94 (D ≥ 60-no-LLDS), P < 0.05. After a median follow-up of 3 years, the 1- and 3-year graft survival rates of group D ≥ 60-LLDS (84% and 76%) were comparable with group D < 60-no-LLDS (89% and 76%) and were significantly higher than group D ≥ 60-no-LLDS (71% and 54%), P < 0.005. In conclusion, the LLDS optimized the use of livers from elderly donors.
Results of Liver Transplantation from Donors Over 75 Years: Case Control Study
Transplantation Proceedings, 2011
Introduction. The use of elderly donors can increase the pool of organs available for transplant. The aim of this study was to analyze the outcomes of grafts from donors older than 75 years. Patients and methods. We selected 29 patients transplanted from January 2003 to January 2010 with livers from donors older than 75 years for comparison with a control group (58 patients), selected among patients transplanted immediately before or after each study case. Data analyzed using SPSS 15.0 were considered statistically significant at P Ͻ .05. Results. Statistically significant differences were evident in the mean age of donors (78.3 Ϯ 2.9 vs 50.4 Ϯ 17.8 years, P Ͻ .001), levels of aspartate aminotransferase alanine aminotransferase (30.8 Ϯ 18.13/24.9 Ϯ 14.4 vs 53.81 Ϯ 68.4/39.37 Ϯ 39.94 U/L, P Ͻ .05), and waiting list time of (122.4 Ϯ 94.3 vs 169.2 Ϯ 135.5 days, P ϭ .034) of elderly donor versus control graft cohorts. The median follow-up was 32 months (range: 4 -88.0) No differences were observed at 1 and 3 years after transplantation: graft survival was 78% and 61% in the older donor group and 83% and 71% in the younger donor group, respectively. Conclusion. The use of expanded donors from elderly subjects can increase the donor pool with good results.
Results of Liver Transplantation With Donors Older than 75 Years: A Case-Control Study
Transplantation Proceedings, 2016
Aim: The inclusion of elderly donors can increase the pool of organs available for transplant. Background: To compare clinical outcomes and survival rates in patients who received livers from donors aged ≥ 80 years vs. younger donors. Methods: We considered all liver transplantations performed in our unit between January 2006 and January 2015. Twelve patients received liver from a cadaveric donor aged ≥ 80 years (study group) and their outcomes were compared with those of patients who received liver from a younger donor (control group). This study was carried out to analyze the characteristics of donors and recipients, as well as the clinical course and survival of recipients. Results: Statistically significant differences were observed in donors' age (55.6 ± 14.4 vs. 82.7 ± 2.7 years, p < 0.001), donors' ICU stay (p = 0.008), donors' ALT levels (p = 0.009) and donors' AST levels (p = 0.01). Statistically significant differences were found in ischemia time (p < 0.05). In total, 8.3% of the recipients of liver from a donor aged < 80 required retransplantation vs. 25% of recipients of donor's ≥ 80 years. Patient survival at one, three and five years was 89%, 78.6% and 74.5%, respectively vs. 83.4%, 79.4% and 59.6% for the study group. Conclusion: Livers from older donors can be safely used for transplantation with acceptable patient survival rates. However, graft survival rates are lower for recipients of livers from older donors as compared to younger donors, and survival only increased with retransplantation.
Long-term survival of recipients of liver grafts from donors older than 80 years: Is it achievable?
Liver Transplantation, 2003
Isolated cases or small series of orthotopic liver transplantation (OLT) with grafts from donors older than 80 years have been reported, but the long-term outcome of patients receiving livers from extremely old donors is unknown. From 1998 to 2003, we performed 17 OLTs with donors older than 80 years (median, 82 years; range, 80 to 87 years). No deaths occurred in the early postoperative period. We analyzed the outcome in 12 patients with a follow-up longer than 1 year. Hepatic insufficiency was caused by hepatitis C virus (HCV)-related cirrhosis in five cases (42%) and non-HCV-related diseases in seven cases (58%). All donors had normal liver function, hemodynamic stability, and no parenchymal alterations. OLT was uneventful in all cases. Median follow-up was 30.3 months (range, 17 to 42 months). No late vascular complications occurred. One patient (8.3%) died 3 years after OLT for causes unrelated to hepatic dysfunction. Twoand 3-year actuarial survival rates were 100% and 75%, respectively. All HCV-positive (HCV ؉ ) patients developed hepatitis recurrence (after 2, 3, 4, 5, and 22 months) requiring antiviral treatment in 3 patients and leading to graft cirrhosis in 1 patient. Non-HCV ؉ patients had wellpreserved liver function throughout the observation period. At the end of follow-up, we observed no clinical hepatic decompensation in the entire group and biochemical signs of recurrent disease in 3 patients. Use of grafts for OLT from donors older than 80 years is safe because of their potentially normal functional recovery. A selection among available organs is mandatory to minimize other risk factors for poor outcome. Long-term patient and graft survival seem to be achievable, but the high rate and rapidity of HCV reinfection remain a major concern for HCV ؉ patients.
Advanced Donor Age Alone Does Not Affect Patient or Graft Survival after Liver Transplantation
Journal of the American College of Surgeons, 2008
BACKGROUND: Individuals greater than 60 years old donate an important portion of the organs available for orthotopic liver transplantation (OLT), but use of donors in this age group remains controversial. We hypothesized that proper selection of donors older than age 60 would not disadvantage recipients in terms of patient and graft survival. STUDY DESIGN: All OLTs performed at our center between January 1, 1990, and July 31, 2007, were divided into groups based on donor age: donors 60 years old or more and donors less than 60 years old. Recipients in each group were compared based on graft and patient survival at 1, 3, and 5 years, Model for End-Stage Liver Disease (MELD) scores, cold ischemic times, and era of transplant (before or after 2001).
A Revised Consideration on the Use of Very Aged Donors for Liver Transplantation
American Journal of Transplantation, 2001
The upper age limit for organ donation for liver transplantation has increased over the past few years. A retrospective case control study was carried out to evaluate the outcome of 36 liver transplants (group A) performed with grafts procured from donors over 70 years old in the period 1996 to April 2000, matched with 36 transplants (group B) chronologically performed thereafter with organs procured from donors below the age of 40 yr. The groups were comparable as regards main clinical characteristics. Mean followup was 14.5 months. Clinical and laboratory parameters of the donors, cold ischemia period, intraoperative blood transfusions, 30-d mortality, incidence of primary graft nonfunction, acute rejection episodes, arterial complications and long-term survival of recipients were considered. The main postoperative biochemical parameters were also collected and compared. A liver biopsy was obtained in 20/36 old donors, revealing less than 25% of steatosis in all but one, which showed steatosis involving 70% of the hepatocytes. There were two postoperative deaths (5.6%) in group A and one (2.8%) in group B (p ΩNS). Seven postoperative arterial complications (19.4%) occurred in group A, leading to the patient's death because of rupture of the hepatic artery in one case, to successful surgical revascularization in three cases and to retransplantation in three cases. Only one patient in group B (2.8%) experienced hepatic artery thrombosis (p Ω 0.055). One-year patient survival rates were 77.4% for group A and 88.8% for group B (p ΩNS); 1-yr graft survival rates were 73.3% for group A and 85.7% for group B( pΩNS). In conclusion, donors over 70 should not be excluded a priori for liver transplantation in elective settings. Great attention should be paid to the pathological conditions of arterial vessels caused by atherosclerosis, i.e. the presence of calcified plaques on the hepatic artery, which might represent the source of severe complications.
Liver Transplantation, 2008
Advanced donor age is a risk factor for poor outcome in liver transplantation (LT). We reviewed 553 consecutive transplants according to donor age categories [group 1 (n = 173): <50 years; group 2 (n = 96): 50–59 years; group 3 (n = 132): 60–69 years; group 4 (n = 111): 70–79 years; group 5 (n = 41): ≥80 years]. Clinical parameters were comparable between groups. Group 5 had the highest proportion of pretransplant liver biopsy (85%), with only 1 graft showing macrovesicular steatosis > 30%, and the lowest ischemia time. Five-year graft survival was significantly higher in group 1 (75%) versus groups 3 (60%) and 4 (62%; P = 0.01 and P = 0.001, respectively) and in group 5 (81%) versus groups 3 and 4 (P = 0.04 and P = 0.01, respectively). Donor age of 60–79 years, recipient hepatitis C virus–positive status, Model for End-Stage Liver Disease score ≥ 25, and emergency LT were predictors of poor survival. In hepatitis C virus–positive patients, 5-year graft survival was 72% in group 1, 85% in group 2, 52% in group 3, 65% in group 4, and 71% in group 5 (group 1 versus group 3, P = 0.04; group 2 versus group 3, P = 0.03). In conclusion, older donor grafts managed with routine graft biopsy and short ischemia time may work effectively, regardless of the severity of the recipient's liver disease. Liver Transpl, 2008. © 2008 AASLD.
Liver Transplantation With Donors Older Than 75 Years
Transplantation Proceedings, 2011
Introduction. Orthotopic liver transplantation has shown successful results over the last years. For this reason there are increased numbers of patients on waiting lists. To expand the pool of liver donors, elderly donors have been used as a strategy. Objective. We report our experience comparing donors of Ն75 years with younger ages for their characteristics, clinical outcomes, and survivals. Methods. From January 2001 to December 2009, we performed 174 consecutive liver transplantation from cadaveric donors in 166 patients. During this period, we used 24 liver grafts from donors Ն 75 years. We analyzed their outcomes retrospectively, describing donors and recipient characteristics and their clinical evolution. Results. The mean follow-up time among the entire study population was 42 Ϯ 39 months. We observed an overall survival of 68.3% with similar incidences in both groups: 83% in the younger versus 78% in the older group at 1 year, and 69% versus 63%, at 5 years respectively. Both groups showed similar lengths of intensive care unit stay, cold and warm ischemia times, and intraoperative transfusion requirements. The older group had a total operative time than was longer and fewer hypotensive episodes than the younger group. There were no significant differences in the rates of rejection and retransplantation between the groups. The use of older donor livers was associated with a significally higher rate of poor initial graft function (P ϭ .027), an increased number of reinterventions (P ϭ .013) in the older donor group, as well as more frequent vascular and biliar complications, without reaching significance. Conclusion. Our data suggested that donor age alone did not engendered a survival disadvantage for graft or recipient. However, careful donor selection is needed to avoid additional risk factors that can increase the morbidity or mortality of the procedure.