Optimization of long-term graft survival after liver transplantation: the role of donor age (original) (raw)
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Influence of donor age on graft survival
Actas urológicas españolas, 2010
In 2007 in Spain 43% of donors were older than 60 years. This produces a worse graft quality and probably a worse survival. Objective: Our objective is to analyze the influence of donor age on graft survival. Material and methods: We analyze retrospectively 216 renal consecutive transplants realized between 2000 and 2008. A univariate and multivariate study (Cox regression) was performed and Kaplan-Meyer test with log rank for graft survival. Results: Follow-up mean of 40 months (±33,4 SD). The univariate analysis of graft survival showed that donor age had a significative influence on graft survival. (OR=1.03; 95% CI 1.01-1.05) (p: 0.009). Studying the relation between donor and recipient age we find an inverse correlation (Pearson's Correlation: 0.55. p<0.0001), but there are significative differences after the adjustment for recipient age.
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.
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).
Donors Older Than 70 Years in Liver Transplantation
Transplantation Proceedings, 2005
Introduction. Expansion of donor criteria has become necessary with the increasing number of liver transplantation candidates, as aged donors who have been considered to yield marginal organs. Methods. Our database of 477 liver transplants (OLT) included 55 cases performed from donors at least 70 years old vs 422 with younger donors. We analyzed pretransplantation donor and recipient characteristics as well as evolution of the recipients. Results. The old donor group showed significantly lower ALT (23 Ϯ 17 vs 48.9 Ϯ 67; P ϭ .0001) and LDH (444 Ϯ 285 vs 570 Ϯ 329; P ϭ .01). There was a trend toward fewer hypotensive events in the aged donor group (27.2% vs 40.5%; P ϭ .07). No steatosis (Ͼ10%) was accepted in the old donor group. Cold ischemia time was statistically shorter for the aged donors (297 Ϯ 90 minutes vs 346 Ϯ 139 minutes; P ϭ .03). With these selected donors, the results were not different for primary nonfunction, arterial and biliary complications, hospitalization, acute reoperation or acute retransplantation, and hospital mortality when donors Ն70 years old were compared to younger donors. Functional cholestasis, neither related to rejection nor to biliary complications, was seen more frequently in old donor recipients (40% vs 22%; P ϭ .03). No differences in 1, and 3 year survivals were observed between recipients of donors over 70 years old and these of younger organs: 93.8% and 90.6% vs 90.7% and 82.8%, respectively. Conclusion. When using selected donors Ն70 years old the outcomes were comparable to those obtained with younger donors. Strict selection is necessary to achieve good long-term survival.
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.
Octogenarian Donors in Liver Transplantation
Transplantation Proceedings, 2016
Introduction. Due to the disparity between the number of patients on the list for liver transplantation and the availability of organs, the use of older donors has become necessary. The aim of this study was to investigate the outcomes of liver transplantation using octogenarian donors. Methods. From December 2003 to February 2016, 777 liver transplantations were performed at our institution, 33 of them (4.2%) with donors 80 years old and above. Our policy for the acceptance of these donors is based on preoperative liver function tests, donor hemodynamic stability, and intraoperative normal gross aspect. Octogenarian grafts were deliberately not assigned to retransplantations or to recipients with multiple previous surgical procedures or extensive portal thrombosis. Results. Mean donor age was 82.7 AE 2.1 years, with a range between 80 and 88. Only 12.1% suffered hemodynamic instability during the intensive care unit stay. Three donors (9.1%) had a history of diabetes mellitus. The mean Model for End-Stage Liver Disease score among recipients was 14.7 AE 5.6. Mean cold ischemia time was 302 AE 61 minutes. After a median follow-up of 18.5 months (range 7.5 to 47.5), no graft developed primary nonfunction. We observed hepatic artery thrombosis in 1 patient (3%) and biliary complications in 4 patients (12.5%). There was 1 case of ischemic-type biliary lesion, although it was related to hepatic artery thrombosis. Patient survival at 1 and 3 years was 90.3%, whereas graft survival was 92.6% and 86.4%, respectively. Conclusions. Excellent mid-term results can be obtained after liver transplantation with octogenarian donors with strict donor selection and adequate graft allocation.
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.
Transplant International, 1992
The impact of high donor age on transplantation outcome was analysed in 1180 consecutive cadaveric grafts transplanted in adult recipients. Grafts were divided into three groups acording to donor age (<55 years (n = 1073, group 1), 55-59 years (n =51, group 2), ~ 60 years (n =56, group 3)) and transplantation outcome was compared for these groups. Criteria investigated were the incidence of primary non-function (PNF), initial function (IF) (urine production first 24 h) and long-term function (LTF). The impact of donor age on LTF was analysed among other potential donor, graft and recipient risk factors by the multivariate proportional hazardous model analysis (Cox model). The incidence of PNF was 5.8% (group 1), 11.8% (group2), and 16.1% (group 3) (P = 0.002). Analysis of paired kidneys of PNF grafts in group 2 and group 3 revealed good function for all paired grafts except for one in each group. IF was anuria in 19.7% of group 1, 29.4% group 2 and 21.5% of group 3, oliguria in 18.2% of group 1, 23.5% of group 2 and 32% of group 3. Normal diuresis was found in 62.1% of group, 47.1% of group 2 and 47.3% of group 3 (P = 0.05). Independent risk factors for graft survival were year of transplantation, recipient age, panel reactive antibodies, donor age group and number of transplantation. After the exclusion of PNF grafts from the analysis, recipient age, year of transplantation and level of panel reactive antibodies remained as independent risk factors.
The impact of donor age on the results of renal transplantation
Nephrology Dialysis Transplantation, 2004
Background. The use of elderly donors is becoming more frequent. An increase in the donor's age is associated with a greater incidence of delayed graft function (DGF), chronic allograft nephropathy (CAN) and worse graft survival. Poor renal graft function is a risk factor for cardiovascular (CV) complications and, finally, for mortality of the patients. Methods. A total of 3365 adult patients transplanted in 1990 (n ¼ 824), 1994 (n ¼ 1075) and 1998 (n ¼ 1466) with a functioning graft after the first year were included. The impact of donor age on renal function, DGF, acute rejection and other clinical factors was evaluated according to two donor and recipient age categories: young (<60 years old) and elderly (60 years old). Additionally, donor age was categorized by decades for the analysis of patient and graft survival, acute rejection and CV mortality. Results. Donor mean age significantly increased during the three transplantation periods. A total of 478 out of 3365 donors were older than 60 years. Elderly donors showed an increased risk of DGF (38.9 vs 28.8%) and CAN (56.8 vs 46.2%). Mean serum creatinine at 3 and 12 months and proteinuria were significantly higher in the old donor group. Incidence and severity of acute rejection were similar in both groups. Graft and patient survival were significantly lower in the old donor group. Also, risk of mortality due to CV events was also significantly higher. A linear increase in risk of graft loss, patient death or CV mortality was observed when donor age was divided into 10 year increase subsets. Conclusions. Donor age is a strong predictor of CAN and graft loss. Patient survival is also affected by donor age, particularly by a higher risk of CV mortality.