Effect of donor age and sex on the outcome of liver transplantation*1

Abstract

We correlated donor and recipient factors with graft outcome in 436 adult patients who underwent 462 liver transplants. Donor variables analyzed were age, gender, ABO blood group, cause of death, length of stay in the intensive care unit, use of pressors or pitressin, need for cardiopulmonary resuscitation, terminal serum transaminases, and ischemia time. Recipient variables analyzed were age, gender, primary diagnosis, history of previous liver transplant, ABO blood group, cytotoxic antibody crossmatch, United Network for Organ Sharing (UNOS) status, and waiting time (except for the cross-match results, they were all known at the time of the operation). The endpoint of the analysis was graft failure, defined as patient death or retransplantation. Using multivariate analysis, graft failure was significantly associated with donor age, donor gender, previous liver transplantation, and UNOS 4 status of the recipient. The effect of donor age became evident only when they were older than 45 years. Livers from female donors yielded significantly poorer results, with 2-year graft survival of female to male 55% (95% CI, 45% to 67%); female to female, 64% (95% CI, 54% to 77%); male to male, 72% (95% CI, 66% to 78%); and male to female, 78% (95% CI, 70% to 88%). The only donors identified as questionable for liver procurement were old (≥60 years) women in whom the adverse age and gender factors were at least additive. However, rather than discard even these livers, in the face of an organ shortage crisis, their individualized use is suggested with case reporting in a special category.As of January 4, 1995, 37,751 transplant candidates were registered on the national waiting list operated by the United Network for Organ Sharing (UNOS), the agency that coordinates organ allocation in the United States. This was a 391% increase from the 9,632 waiting in December 1986. Of the 37,751 in 1995, 4,039 were liver candidates, up from 449 in 1987 (a 900% increase). The supply of all organ donors had undergone a marginal increase between 1988 and 1990 (from 4,085 to 4,514), but has remained relatively stable since then: 4,531 in 1991, 4,521 in 1992, 4,849 in 1993, and 4,891 in 1994. The limited supply of organ donors has increasingly influenced the selection of candidates for liver transplantation, and is used at some institutions to justify restricting the availability of the procedure. 1 Although the exact magnitude of the organ deficit is not yet known, 2,3 the obvious gap between supply and need has stimulated the development of bioartificial liver assist devices, 4 utilization of living related liver donors, 5,6 use of non-heart beating donors, 7-9 and 18,19 or beyond 20 was followed by a flurry of confirmatory reports, 13,14,21,22 countered by descriptions of degraded results using geriatric livers. [23][24][25][26] Less has been written about the effect of donor sex on outcome after liver transplantation, although there is an extensive literature, recently summarized by Neugarten and Silbiger, 27 showing poorer re...

Preoperative assessment of risk in liver transplantation: A multivariate analysis in 2376 cases of the UW Era

“…The latter was defined as the time elapsed from aortic cross-clamping in the donor to portal or arterial reperfusion in the recipient. 7 Recipient variables studied were: age, gender, ABO type, indication for OLTx, history of prior OLTx, history of prior upper abdominal surgery, need for preoperative mechanical ventilation, type of primary immunosuppression, preoperative creatinine, preoperative bilirubin, preoperative prothrombin time, and UNOS urgency status. UNOS status is a measure of severity of disease, according to UNOS candidate classification: UNOS 1: patient stable at home; UNOS 2: waiting at home, but requiring medical support; UNOS 3: unstable, in need of continuous hospitalization; UNOS 4: requirement of life-support systems.…”