Octogenarian liver grafts: Is their use for transplant currently justified?

Abstract

AIMTo analyse the impact of octogenarian donors in liver transplantation.METHODSWe present a retrospective single-center study, performed between November 1996 and March 2015, that comprises a sample of 153 liver transplants. Recipients were divided into two groups according to liver donor age: recipients of donors ≤ 65 years (group A; n = 102), and recipients of donors ≥ 80 years (group B; n = 51). A comparative analysis between the groups was performed. Quantitative variables were expressed as mean values and SD, and qualitative variables as percentages. Differences in properties between qualitative variables were assessed by χ2 test. Comparison of quantitative variables was made by t-test. Graft and patient survivals were estimated using the Kaplan-Meier method.RESULTSOne, 3 and 5-year overall patient survival was 87.3%, 84% and 75.2%, respectively, in recipients of younger grafts vs 88.2%, 84.1% and 66.4%, respectively, in recipients of octogenarian grafts (P = 0.748). One, 3 and 5-year overall graft survival was 84.3%, 83.1% and 74.2%, respectively, in recipients of younger grafts vs 84.3%, 79.4% and 64.2%, respectively, in recipients of octogenarian grafts (P = 0.524). After excluding the patients with hepatitis C virus cirrhosis (16 in group A and 10 in group B), the 1, 3 and 5-year patient (P = 0.657) and graft (P = 0.419) survivals were practically the same in both groups. Multivariate Cox regression analysis demonstrated that overall patient survival was adversely affected by cerebrovascular donor death, hepatocarcinoma, and recipient preoperative bilirubin, and overall graft survival was adversely influenced by cerebrovascular donor death, and recipient preoperative bilirubin.CONCLUSIONThe standard criteria for utilization of octogenarian liver grafts are: normal gross appearance and consistency, normal or almost normal liver tests, hemodynamic stability with use of < 10 μg/kg per minute of vasopressors before procurement, intensive care unit stay < 3 d, CIT < 9 h, absence of atherosclerosis in the hepatic and gastroduodenal arteries, and no relevant histological alterations in the pre-transplant biopsy, such as fibrosis, hepatitis, cholestasis or macrosteatosis > 30%.

Transplantation With Livers From Deceased Donors Older Than 75 Years

“…The reported incidence of HAT lies between 1.6% and 4% in adult recipients 101,102,283 . Two patients (3,7%) both in the D75 group and the control group experienced HAT or stenosis, which is in line with other recent studies showing no increased occurrence of arterial complications in grafts from older compared to younger donors 203,205,206,273,274 .…”

“…Similar results were published by Jimenez-Romero et al in 2017, with 64% 5-year GS for recipients from donors above 80 years. When HCV-positive recipients were excluded, 5-year GS rose to 77% 206 and found no difference in 5-year-all-cause graft loss when older livers were given to so-called preferred recipients, defined as first-time, non-urgent patients older than 45 years with BMI below 35 and indication for LT other than HVC and CIT under 8 hours 208 .…”

“…In 15 of these 16 patients the biliary complications derived from the common bile duct. Earlier studies on the use of old liver donors have raised concerns regarding increased risk for biliary complications, but the available data are conflicting as some studies show increased risk while other reports do not show any association 177,178,205,206,273,278,279 . Some studies have highlighted that old donor age is an independent risk factor for ischemic-type biliary lesions (ITBL) with incidence ranging from 4% to 25% 178,279 .…”

Pushing the donor limits: Deceased donor liver transplantation using organs from octogenarian donors

“…In fact, with the growing use of elderly donors due to the unacceptable death rate in waiting lists, more favorable results have been demonstrated in recent studies using organs from donors older than 60, 70, and even 80 years of age …”

“…In fact, with the growing use of elderly donors due to the unacceptable death rate in waiting lists, more favorable results have been demonstrated in recent studies (28)(29)(30)(31)(32)(33)(34) using organs from donors older than 60, 70, (35)(36)(37)(38)(39)(40)(41) and even 80 years of age. (20,26,28,41) There remains, however, concerns about the higher risk for primary nonfunction, delayed graft function, and worst longterm graft survival with the use of these super-old septuagenarian and octogenarian donors. (10,23,24) Among several octogenarian series, 1-, 3-, and 5-year patient survival range between 75% and 100%, 40% and 86%, and 78.2% and 86%, respectively, (8,14,26,(42)(43)(44) whereas 1-, 3-, and 5-year graft survival varies between 75% and 100%, 61.2% and 81%, and 77.1% and 81%, respectively (Table 1).…”