Orthotopic Liver Transplantation: Preliminary Analysis of Complications With Grafts From Elderly Donors

Naranjo-Izurieta, J.R.; Azúa-López, Z. Ruiz de; Lameirao, J.; Martín-Villén, Luis; Roldán-Reina, A.J.; Porras-López, M.; Rodríguez-Rodríguez, A.; Egea-Guerrero, Juan José

doi:10.1016/j.transproceed.2017.12.034

Cited by 2 publications

(1 citation statement)

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“…We considered graft survival a primary outcome because information on biliary complications or early bile production was not available in the ET database. This is a potential limitation because some studies found suggestions for more biliary complications in transplantations with livers from elderly donors . However, biliary complications will likely also affect graft survival in the long run.…”

Section: Discussionmentioning

confidence: 99%

Optimizing the Use of Geriatric Livers for Transplantation in the Eurotransplant Region

et al. 2019

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Acceptance criteria for liver allografts are ever more expanding because of a persisting wait‐list mortality. Older livers are therefore offered and used more frequently for transplantation. This study aims to analyze the use and longterm outcome of these transplantations. Data were included on 17,811 first liver transplantations (LTs) and information on livers that were reported for allocation but not transplanted from 2000 to 2015 in the Eurotransplant (ET) region. Graft survival was defined as the period between transplantation and date of retransplantation or date of recipient death. In the study period, 2394 (13%) transplantations were performed with livers ≥70 years old. Graft survival was 74%, 57%, and 41% at 1‐, 5‐, and 10‐year follow‐up, respectively. A history of diabetes mellitus in the donor (hazard ratio [HR], 1.3; P = 0.01) and positive hepatitis C virus antibody in the recipient (HR, 1.5; P < 0.001) are specific risk factors for transplantations with livers ≥70 years old. Although donor age is associated with a linearly increasing risk of graft loss between 25 and 80 years old, no difference in graft survival could be observed when “preferred” recipients were transplanted with a liver <70 or ≥70 years old (HR 1.1; CI 0.92‐1.23, P = 0.40) or with a donor <40 or ≥70 years old (HR 1.2; CI 0.96‐1.37, P = 0.13). Utilization of reported livers ≥70 years old increased from 42% in 2000‐2003 to 76% in 2013‐2015 without a decrease in graft survival ( P = 0.45). In conclusion, an important proportion of LTs in the ET region are performed with livers ≥70 years old. The risk of donor age on graft loss increases linearly between 25 and 80 years old. Livers ≥70 years old can, however, be transplanted safely in preferred patients and are to be used more frequently to further reduce wait‐list mortality.

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Section: Discussionmentioning

confidence: 99%