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

Jaime, Francia Díaz; Berenguer, Marina

doi:10.1002/lt.24841

Cited by 13 publications

(14 citation statements)

References 52 publications

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“…Even though advanced donor age was almost always associated with worse outcomes in large populations, several series have shown acceptable results with septuagenarian or octogenarian donors. 11,[96][97][98][99][100][101][102] Similar results have been reported with older donors as younger donors up to 5 years after transplantation, with survival rates exceed-ing 70% in most cases. However, it was emphasised that donors older than 70 years of age should be carefully selected and that cold ischaemia time should be reduced.…”

Section: Age Of the Donorsupporting

confidence: 75%

Age and liver transplantation

Durand

Levitsky

Cauchy

et al. 2019

Journal of Hepatology

229

209

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The average age of liver transplant donors and recipients has increased over the years. Independent of the cause of liver disease, older candidates have more comorbidities, higher waitlist mortality and higher post-transplant mortality than younger patients. However, transplant benefit may be similar in older and younger recipients, provided older recipients are carefully selected. The cohort of elderly patients transplanted decades ago is also increasingly raising issues concerning long-term exposure to immunosuppression and aging of the transplanted liver. Excellent results can be achieved with elderly donors and there is virtually no upper age limit for donors after brain death liver transplantation. The issue is how to optimise selection, procurement and matching to ensure good results with elderly donors. The impact of old donor age is more pronounced in younger recipients and patients with a high model for end-stage liver disease score. Age matching between the donor and the recipient should be incorporated into allocation policies with a multistep approach. However, age matching may vary depending on the objectives of different allocation policies. In addition, age matching must be revisited in the era of direct-acting antivirals. More restrictive limits have been adopted in donation after circulatory death. Perfusion machines which are currently under investigation may help expand these limits. In living donor liver transplantation, donor age limit is essentially guided by morbidity related to procurement. In this review we summarise changing trends in recipient and donor age. We discuss the implications of older age donors and recipients. We also consider different options for age matching in liver transplantation that could improve outcomes.

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Section: Age Of the Donorsupporting

confidence: 75%

Age and liver transplantation

Durand

Levitsky

Cauchy

et al. 2019

Journal of Hepatology

229

209

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“…Various reports demonstrate that transplantation of elderly donor allografts (>80 years) is safe and not associated with inferior overall outcomes per se [47,48]. Septuagenarian and octogenarian donor livers are successfully utilized with acceptable results [49,50]. However, older livers have a reduced functional reserve and regeneration capacity and are therefore more vulnerable to IRI injury; they show a higher incidence of biliary and arterial complications as well as inferior initial graft function [49].…”

Section: The Heterogeneity Of Ecd Graftsmentioning

confidence: 99%

Ischemia-Reperfusion Injury in Marginal Liver Grafts and the Role of Hypothermic Machine Perfusion: Molecular Mechanisms and Clinical Implications

Czigány

Lurje

Schmelzle

et al. 2020

JCM

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Ischemia-reperfusion injury (IRI) constitutes a significant source of morbidity and mortality after orthotopic liver transplantation (OLT). The allograft is metabolically impaired during warm and cold ischemia and is further damaged by a paradox reperfusion injury after revascularization and reoxygenation. Short-term and long-term complications including post-reperfusion syndrome, delayed graft function, and immune activation have been associated with IRI. Due to the current critical organ shortage, extended criteria grafts are increasingly considered for transplantation, however, with an elevated risk to develop significant features of IRI. In recent years, ex vivo machine perfusion (MP) of the donor liver has witnessed significant advancements. Here, we describe the concept of hypothermic (oxygenated) machine perfusion (HMP/HOPE) approaches and highlight which allografts may benefit from this technology. This review also summarizes clinical applications and the main aspects of ongoing randomized controlled trials on hypothermic perfusion. The mechanistic aspects of IRI and hypothermic MP—which include tissue energy replenishment, optimization of mitochondrial function, and the reduction of oxidative and inflammatory damage following reperfusion—will be comprehensively discussed within the context of current preclinical and clinical evidence. Finally, we highlight novel trends and future perspectives in the field of hypothermic MP in the context of recent findings of basic and translational research.

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“…A possible explanation for the increase in utilization of HCV+ livers over recent years is a change in the HCV+ deceased donor population. In their study, HCV+ liver donors used for transplantation in the recent era were more likely to be younger and Caucasian, and less likely to have diabetes, in contrast to what has been observed in the overall donor population over time . Therefore, alongside the improving quality of HCV D+, the declining quality of the overall donor pool may be an additional driver of increasing physician confidence in accepting HCV+ livers.…”

Section: Estimates Of the Potential Number Of Organs From Hcv+ Indivimentioning

confidence: 95%

Should organs from hepatitis C‐positive donors be used in hepatitis C‐negative recipients for liver transplantation?

Selzner

Berenguer

2018

Liver Transpl

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Given the scarcity of donated organs and the frequency of death on the waiting list, strategies that could improve the available supply of high-quality liver grafts are much needed. Direct-acting antiviral agent (DAA) regimens have proved to be highly effective to treat hepatitis C virus (HCV), even in the setting of posttransplantation. The question arises as to whether transplant communities should consider the utilization of HCV-positive donors into HCV-negative recipients. This review summarizes risk of transmission, treatment options with success rate, and ethical considerations for usage of HCV-positive donors. Liver Transplantation 24 831-840 2018 AASLD.

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

Cited by 13 publications

References 52 publications

Age and liver transplantation

Age and liver transplantation

Ischemia-Reperfusion Injury in Marginal Liver Grafts and the Role of Hypothermic Machine Perfusion: Molecular Mechanisms and Clinical Implications

Should organs from hepatitis C‐positive donors be used in hepatitis C‐negative recipients for liver transplantation?

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