Results of Liver Transplantation From Old Donors

Dudek, Krzysztof; Kornasiewicz, Oskar; Remiszewski, Piotr; Zieniewicz, Krzysztof; Wróblewski, Tadeusz; Krawczyk, Marek

doi:10.1016/j.transproceed.2014.09.022

Cited by 14 publications

(8 citation statements)

References 10 publications

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“…Recently, a large analysis of more than 41000 liver transplant recipients receiving a donation after circulatory death showed that recipients of livers from donors with an age below 50 years had a higher survival rate, compared to recipients of livers from donors with an age above 60. However, several studies indicated that older grafts can be used safely with a careful selection of patient and donor in the majority of cases[9-13]. Based on the published literature, strict recommendations for the acceptance or refusal of potential liver donors cannot be made.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with long-term survival after liver transplantation: A retrospective cohort study

Pischke

Lege

Wulffen

et al. 2017

WJH

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AIMTo identify predictive factors associated with long-term patient and graft survival (> 15 years) in liver transplant recipients.METHODSMedical charts of all de novo adult liver transplant recipients (n = 140) who were transplanted in Hamburg between 1997 and 1999 were retrospectively reviewed. In total, 155 transplantations were identified in this time period (15 re-transplantations). Twenty-six orthotopic liver transplant (OLT) recipients were early lost to follow-up due to moving to other places within 1 year after transplantation. All remaining 114 patients were included in the analysis. The following recipient factors were analysed: Age, sex, underlying liver disease, pre-OLT body mass index (BMI), and levels of alanine aminotransferase (ALT), bilirubin, creatinine and gamma-glutamyltransferase (gamma-GT), as well as warm and cold ischemia times. Furthermore, the following donor factors were assessed: Age, BMI, cold ischemia time and warm ischemia time. All surviving patients were followed until December 2014. We divided patients into groups according to their underlying diagnosis: (1) hepatocellular carcinoma (n = 5, 4%); (2) alcohol toxic liver disease (n = 25, 22.0%); (3) primary sclerosing cholangitis (n = 6, 5%); (4) autoimmune liver diseases (n = 7, 6%); (5) hepatitis C virus cirrhosis (n = 15, 13%); (6) hepatitis B virus cirrhosis (n = 21, 19%); and (7) other (n = 35, 31%). The group “other” included rare diagnoses, such as acute liver failure, unknown liver failure, stenosis and thrombosis of the arteria hepatica, polycystic liver disease, Morbus Osler and Caroli disease.RESULTSThe majority of patients were male (n = 70, 61%). Age and BMI at the time point of transplantation ranged from 16 years to 69 years (median: 53 years) and from 15 kg/m2 to 33 kg/m2 (median: 24), respectively. Sixty-six OLT recipients (58%) experienced a follow-up of 15 years after transplantation. Recipient’s age (P = 0.009) and BMI (P = 0.029) were identified as risk factors for death by χ2-test. Kaplan-Meier analysis confirmed BMI or age above the median as predictors of decreased long-term survival (P = 0.008 and P = 0.020). Hepatitis B as underlying disease showed a trend for improved long-term survival (P = 0.049, χ2-test, P = 0.055; Kaplan-Meier analysis, Log rank). Pre-transplant bilirubin, creatinine, ALT and gamma-GT levels were not associated with survival in these patients of the pre-era of the model of end stage liver disease.CONCLUSIONThe recipients’ age and BMI were predictors of long-term survival after OLT, as well as hepatitis B as underlying disease. In contrast, donors’ age and BMI were not associated with decreased survival. These findings indicate that recipient factors especially have a high impact on long-term outcome after liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Factors associated with long-term survival after liver transplantation: A retrospective cohort study

Pischke

Lege

Wulffen

et al. 2017

WJH

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“…More recently, the growing demand for organs in LT has led to the use of increasingly higher risk grafts, in order to reduce the waiting list mortality[10-12]. These include grafts from older donors, prolonged preservation period, graft steatosis, split or partial liver allografts and donation after cardiac death (DCD).…”

Section: Introductionmentioning

confidence: 99%

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

Rahman

Davidson

Mallett

2017

WJH

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AIMTo investigate the additional clinical impact of hepatic ischaemia reperfusion injury (HIRI) on patients sustaining acute kidney injury (AKI) following liver transplantation.METHODSThis was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation (OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT (> 1.5 × baseline) or by the use of continuous veno-venous haemofiltration (CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase (AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor (< 1000 IU/L), moderate (1000-5000 IU/L) or severe (> 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications (AKI and HIRI) alone and then as a combined outcome.RESULTSOut of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustained moderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively (P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation (P < 0.001) and intensive care length of stay (P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication (P = 0.049).CONCLUSIONHIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.

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“…More recently, the growing demand for organs in LT has led to the use of increasingly higher risk grafts, in order to reduce the waiting list mortality [10][11][12] . These include grafts from older donors, prolonged preservation period, graft steatosis, split or partial liver allografts and donation after cardiac death (DCD).…”

Section: Introductionmentioning

confidence: 99%

Early Acute Kidney Injury after Liver Transplantation: Predisposing Factors and Clinical Implications

Rahman¹

2017

Preprint

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Results of Liver Transplantation From Old Donors

Cited by 14 publications

References 10 publications

Factors associated with long-term survival after liver transplantation: A retrospective cohort study

Factors associated with long-term survival after liver transplantation: A retrospective cohort study

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

Early Acute Kidney Injury after Liver Transplantation: Predisposing Factors and Clinical Implications

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