Risk analysis of ischemic‐type biliary lesions after liver transplant using octogenarian donors

Ghinolfi, Davide; Simone, Paolo De; Lai, Quirino; Pezzati, Daniele; Coletti, L; Balzano, E; Arenga, G.; Carrai, P; Grande, Gennaro; Pollina, Luca Emanuele; Campani, Daniela; Biancofiore, Gianni; Filipponi, Franco

doi:10.1002/lt.24401

Cited by 44 publications

(39 citation statements)

References 46 publications

(69 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is in line with the factors that were identified by Ghinolfi et al including a history of diabetes . Diabetes is more often present in older donors and may have a stronger and more chronic effect on the vasculature and parenchyma in older donor livers . Diabetes, therefore, seems to be an important risk factor that should be avoided when possible.…”

Section: Discussionsupporting

confidence: 87%

“…The utilization rate of livers ≥70 years old was even slightly higher at 72% when livers that were used for retransplantations were included (data not shown). These rates are very high in comparison to other studies who report usage rates of approximately 60% and 52%‐63% for liver donors ≥70 years and ≥80 years old, respectively . It does, however, correspond with usage in the United States where 74% of livers of 70 years and older are used for transplantation .…”

Section: Discussioncontrasting

confidence: 60%

“…The latter is present in our study and also observed in these other studies. Older liver allografts have shorter CITs, more often have pretransplant biopsies, have a lower incidence of cardiac arrest, and are more frequently regionally procured . All of these are obviously meant to decrease the initial risk of the geriatric liver allograft.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 60%

See 1 more Smart Citation

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…To support this hypothesis, a recent study on 88 primary LTs demonstrated a significant association between donor DM and ischemic-type biliary lesions with an HR of 9.5 ( P = 0.009), suggesting that DM promotes chronic changes in the biliary vessels, thereby increasing susceptibility to IRI. 22 …”

Section: Discussionmentioning

confidence: 99%

Donor Diabetes and Prolonged Cold Ischemia Time Synergistically Increase the Risk of Graft Failure After Liver Transplantation

Brüggenwirth

Dolgin

Porte

et al. 2017

Transplantation Direct

View full text Add to dashboard Cite

BackgroundBoth prolonged cold ischemia time (CIT) and donor history of diabetes mellitus (DM) are associated with reduced graft survival after liver transplantation. However, it is unknown whether the adverse effect of prolonged CIT on posttransplant graft survival is more pronounced after transplant with DM versus non-DM donor grafts.MethodsThe study sample included 58 226 liver transplant recipients (2002-2015) from the Scientific Registry of Transplant Recipients. Multivariable Cox survival regression with interaction analysis was used to quantify the extent to which history of donor DM (n = 6478) potentiates the adverse effect of prolonged (≥8 hours) CIT (n = 18 287) on graft survival.ResultsDonor DM and CIT 8 hours or longer were each associated with increased risk of graft failure (GF) (adjusted hazard ratio [aHR], 1.19; 95% confidence interval [CI], 1.06-1.35 and aHR, 1.42; 95% CI, 1.32-1.53, respectively) compared with transplanted grafts without either risk factor. However, the combination of DM and CIT 8 hours or longer was associated with a higher risk of GF than either factor alone (aHR, 1.79; 95% CI, 1.55-2.06) and had a synergy index of 1.30. The interaction was significant on a multiplicative scale in the later postoperative period, days 31 to 365 (P = 0.047).ConclusionsThese results suggest that liver grafts from DM donors are more susceptible to the adverse effects of prolonged CIT than livers from non-DM donors. We need to be cognizant that they are more susceptible to ischemic injury, and this may be considered during the allocation process.

show abstract

“…In conclusion, we thank Ghinolfi et al (1) for the precious research they are carrying on, and we encourage other groups to share their experience on octogenarian liver grafts. …”

mentioning

confidence: 88%

Liver transplant using octogenarian donors

et al. 2016

View full text Add to dashboard Cite

We read with interest the article from Ghinolfi et al. (1) about the risk of ischemic-type biliary lesions using octogenarian grafts. In this study, the authors show favorable results with accurately selected very old donors.In Europe, life expectancy has risen at a steady pace of 2.5 years per decade for a century and a half, (2,3) piercing inexorably all the life-span ceilings predicted over time by scientists, and nowadays, the ultimate limit to human age is unforeseeable. If death occurs in increasingly older individuals, it is reasonable to expect deceased donor age to rise as well. In accordance with this hypothesis, Ghinolfi et al. (4) report that liver transplantations (LTs) from octogenarian donors increased constantly between 2001 (3.5%) and 2010 (16.1%); this result is consistent with data from Spain (5) and from the European Liver Transplant Registry. (6) In our series (1571 liver transplants performed between December 1985 and December 2015), the first LT with an octogenarian donor was in 2002; in 2015, 11% of LTs were performed with octogenarian grafts. The mean and median donor age increased significantly (P < 0.001 for both) in an exquisitely linear manner (r 2 5 0.97 and 0.93 respectively; slope 5 1.27 [95% confidence interval (CI), 1.19-1.35] and 1.50 [95% CI, 1.35-1.65], respectively; Fig. 1), reaching the current value of 60.7 and 62 years, respectively. According to this model, we will reach the donor median age of 80 years in 1 decade (9.92 years; 95% CI, 6.28-14.34), meaning that in 2025 the majority of LTs could be performed with a graft aged 80 years or more (Fig. 1).Furthermore in the current decade, the control over HCV infection (an independent predictor of poor survival in transplants from octogenarian grafts (4) ) may lessen concerns on accepting and allocating very old grafts thus increasing their use.In conclusion, we thank Ghinolfi et al.(1) for the precious research they are carrying on, and we encourage other groups to share their experience on octogenarian liver grafts.

show abstract

Risk analysis of ischemic‐type biliary lesions after liver transplant using octogenarian donors

Cited by 44 publications

References 46 publications

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

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

Donor Diabetes and Prolonged Cold Ischemia Time Synergistically Increase the Risk of Graft Failure After Liver Transplantation

Liver transplant using octogenarian donors

Contact Info

Product

Resources

About