Age Matching of Elderly Liver Grafts With Elderly Recipients Does Not Have a Synergistic Effect on Long-term Outcomes When Both Are Carefully Selected

Gilbo, Nicholas; Jochmans, Ina; Sainz-Barriga, Mauricio; Nevens, Frederik; Merwe, Schalk van der; Laleman, Wim; Verslype, Chris; Cassiman, David; Verbeke, Len; Malenstein, Hannah van; Roskams, Tania; Pirenne, Jacques; Monbaliu, Diethard

doi:10.1097/txd.0000000000000883

Cited by 10 publications

(8 citation statements)

References 44 publications

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“…[3,5,6] Some studies suggest that the use of septuagenarian or octogenarian donors results in similar clinical outcomes and shortterm survival rates compared with the use of donors younger than 65, whereas other studies suggest that the use of septuagenarian or octogenarian donors decreased survival and increased risk of ischemiareperfusion injury and biliary complications. [2,4,[7][8][9][10][11][12] However, most of these analyses have been completed on recipients with an average age between 50 and 60 years old while focusing on short-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the outcomes of donor-recipient age differences in young adults undergoing liver transplantation

Snyder

Kojima

Imaoka

et al. 2023

Liver Transplantation

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The current liver allocation system may be disadvantaging younger adult recipients as it does not incorporate the donor-recipient age difference. Given the longer life expectancy of younger recipients, the influences of older donor grafts on their long-term prognosis should be elucidated. This study sought to reveal the long-term prognostic influence of the donor-recipient age difference in young adult recipients. Adult patients who received initial liver transplants from deceased donors between 2002 and 2021 were identified from the UNOS database. Young recipients (patients 45 years old or below) were categorized into 4 groups: donor age younger than the recipient, 0-9 years older, 10-19 years older, or 20 years older or above. Older recipients were defined as patients 65 years old or above.To examine the influence of the age difference in long-term survivors, conditional graft survival analysis was conducted on both younger and older recipients.Among 91,952 transplant recipients, 15,170 patients were 45 years old or below (16.5%); these were categorized into 6,114 (40.3%), 3,315 (21.9%), 2,970 (19.6%), and 2,771 (18.3%) for groups 1-4, respectively. Group 1 demonstrated the highest probability of survival, followed by groups 2, 3, and 4 for the actual graft survival and conditional graft survival analyses. In younger recipients who survived at least 5 years post-transplant, inferior long-term survival was observed when there was an age difference of 10 years or above (86.9% vs. 80.6%, logrank p < 0.01), whereas there was no difference in older recipients (72.6% vs. 74.2%, log-rank p = 0.89). In younger patients who are not in emergent need of a transplant, preferential allocation of younger aged donor offers would optimize organ utility by increasing postoperative graft survival time.

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Section: Introductionmentioning

confidence: 99%

Evaluating the outcomes of donor-recipient age differences in young adults undergoing liver transplantation

Snyder

Kojima

Imaoka

et al. 2023

Liver Transplantation

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“…In contrast, a positive effect on patient survival was previously observed in our center. 3 In line with this, we did not claim that thoracic organs donation correlates with poor post-LT outcomes.…”

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confidence: 61%

Reply to: “The Impact of Donor Hepatectomy Time on Liver Transplantation Outcomes”

et al. 2022

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“… 49 In an age-matched LT study, older recipients were at higher risk of death posttransplant, independent of age matching, and the predictors of poor prognosis were high MELD scores, retransplant, and prolonged CIT. 75 Elderly donors did not affect patient survival, and, even though the recipient’s age independently increased the risk of death, matching older donors to older recipients did not confer an additional risk. The optimal recipients of older donor grafts are first-time recipients, those with body mass index less than 35, non–status 1, low biological MELD score, and CIT of less than 8 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Resulting evidence therefore supports the use of older livers in older recipients, as long as other risk factors are minimized. 75 Grafts from donors older than 70 years of age are still underused in some parts of the United States, with a discard rate of approximately 26%, but the use of older donor organs could be optimized by adjusting for aforementioned recipient-specific factors. Current UNOS/OPTN allocation for livers does not follow age matching, but transplant centers assign the livers from elderly donors in the appropriately selected patient populations in whom the strategy was proved to be safe.…”

Section: Discussionmentioning

confidence: 99%

Transplant of Elderly Patients

Cottone

Polanco

Bhamidimarri

2021

Clinics in Liver Disease

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Increased life expectancy and advances in the care of chronic liver disease has increased the number of elderly patients needing liver transplant. Organ donation policies prioritize transplant to the sickest. There is an ongoing debate with regard to balancing the principles of equity and utility. Several hospitals have adopted center-specific policies and there has been an increased trend of transplant in elderly patients since 2002. Appropriate patient selection and long-term outcomes in the setting of limited organ availability pose several challenges. This article reviews the data and discusses the pros and cons of transplants in the elderly.

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Age Matching of Elderly Liver Grafts With Elderly Recipients Does Not Have a Synergistic Effect on Long-term Outcomes When Both Are Carefully Selected

Abstract: Supplemental digital content is available in the text.

Cited by 10 publications

References 44 publications

Evaluating the outcomes of donor-recipient age differences in young adults undergoing liver transplantation

Evaluating the outcomes of donor-recipient age differences in young adults undergoing liver transplantation

Reply to: “The Impact of Donor Hepatectomy Time on Liver Transplantation Outcomes”

Transplant of Elderly Patients

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