How Old Is Old? An Age-Stratified Analysis of Elderly Liver Donors above 65

Abstract

In liver transplantation, older donor age is a well-known risk factor for dismal outcomes, especially due to the high susceptibility of older grafts to ischemia-reperfusion injury. However, whether the factors correlating with impaired graft and patient survival following the transplantation of older grafts follow a linear trend among elderly donors remains elusive. In this study, liver transplantations between January 2006 and May 2018 were analyzed retrospectively. Ninety-two recipients of grafts from donors ≥65 years were identified and divided into two groups: (1) ≥65–69 and (2) ≥ 70 years. One-year patient survival was comparable between recipients of grafts from donors ≥65–69 and ≥70 years (78.9% and 70.0%). One-year graft survival was 73.1% (donor ≥65–69) and 62.5% (donor ≥ 70), while multivariate analysis revealed superior one-year graft survival to be associated with a donor age of ≥65–69. No statistically significant differences were found for rates of primary non-function. The influence of donor age on graft and patient survival appears not to have a distinct impact on dismal outcomes in the range of 65–70 years. The impact of old donor age needs to be balanced with other risk factors, as these donors provide grafts that offer a lifesaving graft function.

Bariatric surgery in liver cirrhosis

“…According to our experience, we agree with the IFSO on evaluating patients suffering from NAFLD for TIPS implantation and consecutive SG. However, in Germany, we are facing severe organ scarcity and would not be able to facilitate LT for many cases after BS in due time ( 43 ). These patients typically present with a low MELD score with a very long waiting time on the waiting list.…”

Emergencies Following Orthotopic Liver Transplant

“…Additionally, studies on donor age and graft loss in liver transplantation have seldomly studied PNF as an etiology. In a recent study by Houben et al [26] the authors stratified liver transplant donors into two groups, (65-69 years and ≥ 70 years) and found no statistical difference for rates of PNF between the groups. Additionally, that study found that one-year patient survival was not statistically different for donors <65 years and donors of 65-69 years (77.1% vs. 78.5%).…”

Innate Immune Cells during Machine Perfusion of Liver Grafts—The Janus Face of Hepatic Macrophages

“…MP has shown substantial benefits compared to the conventionally used technique of static cold storage (SCS), especially considering the ever-growing dependence on organs with a higher susceptibility to IRI. These livers from extended criteria donors (ECD) usually combine multiple risk factors such as elevated donor age [8], steatosis (macrosteatosis > 30%, mixed steatosis > 60%), or prolonged cold ischemia time (CIT). In addition to maintaining organ viability, continuous oxygenated perfusion replenishes mitochondrial adenosine triphosphate (ATP) stores [9] and protects the organ by eliminating acidotic waste products.…”