Effects of Donor Age and Cold Ischemia on Liver Transplantation Outcomes According to the Severity of Recipient Status

Abstract

BackgroundProlonged cold ischemic time (CIT) and increased donor age are well-known factors negatively influencing outcomes after liver transplantation (LT).AimsThe aim of this study was to evaluate whether the magnitude of their negative effects is related to recipient model for end-stage liver disease (MELD) score.MethodsThis retrospective study was based on a cohort of 1402 LTs, divided into those performed in low-MELD (<10), moderate-MELD (10–20), and high-MELD (>20) recipients.ResultsWhile neither donor age (p = 0.775) nor CIT (p = 0.561) was a significant risk factor for worse 5-year graft survival in low-MELD recipients, both were found to yield independent effects (p = 0.003 and p = 0.012, respectively) in moderate-MELD recipients, and only CIT (p = 0.004) in high-MELD recipients. However, increased donor age only triggered the negative effect of CIT in moderate-MELD recipients, which was limited to grafts recovered from donors aged ≥46 years (p = 0.019). Notably, utilization of grafts from donors aged ≥46 years with CIT ≥9 h in moderate-MELD recipients (p = 0.003) and those with CIT ≥9 h irrespective of donor age in high-MELD recipients (p = 0.031) was associated with particularly compromised outcomes.ConclusionsIn conclusion, the negative effects of prolonged CIT seem to be limited to patients with moderate MELD receiving organs procured from older donors and to high-MELD recipients, irrespective of donor age. Varying effects of donor age and CIT according to recipient MELD score should be considered during the allocation process in order to avoid high-risk matches.

Cold ischemia time is an important risk factor for post–liver transplant prolonged length of stay

“…In a more complete clinical picture, prior risk analysis of CIT alongside other donor and patient variables reveals several interactions. Although the use of grafts from elderly donors does increase graft loss alone, it has been previously demonstrated that elderly grafts with prolonged cold ischemia have increased risk for graft loss at 5 years . It has also been shown that grafts with prolonged cold ischemia have lower graft survival when transplanted in moderate‐ and high‐MELD recipients but not when transplanted in low‐MELD recipients .…”

“…Although the use of grafts from elderly donors does increase graft loss alone, it has been previously demonstrated that elderly grafts with prolonged cold ischemia have increased risk for graft loss at 5 years . It has also been shown that grafts with prolonged cold ischemia have lower graft survival when transplanted in moderate‐ and high‐MELD recipients but not when transplanted in low‐MELD recipients . Given the clear potential for confounding, our analysis controlled for numerous variables to isolate the effect of CIT.…”

Graft Risk Index After Liver Transplant: Internal and External Validation of a New Spanish Indicator

“…We agree with Feng and associates 5 that an ideal graft is homogeneous, allowing allocation of an optimal organ to anyone; however, nonideal grafts are heterogeneous, covering a wide spectrum of risk. In the latter case, allocating a suboptimal organ to a recipient with high MELD, 28,29 specific conditions, 30 or conditions with higher wait list mortality could interfere with the risk of patient survival against wait list mortality. 31 Therefore, an indicator should include this aspect in its design.…”

Infecções Relacionadas À Assistência À Saúde E Fatores Associados No Pós-Operatório De Transplante Hepático

“…2,[12][13][14][15] Recurrence of hepatitis C is still common, persisting as the main problem of patients who are transplanted due to viral hepatitis, in need of effective treatment and, even, retransplant. 15 Among the fifteen patients who were notified with HCRI, only two were diagnosed with hepatitis C, presenting statistical significance in relation to the non-occurrence of HCRI, different from what has been found in an international study with univariate analysis, whose sample comprised 17 liver receptors with infection, and 34 without infection.…”

“…In the international literature, transplanted patients presented a rate of 82.5%. 13 Research conducted at a single European center examined the survival of 313 liver receptors within two decades after the transplantation, pointing to infection as one of the most common causes of death after the surgical procedure. Of the patients analyzed, 141 died up to twenty years after the transplant, being 29 (20.6%) caused by various infections.…”