Septuagenarian and Octogenarian Donors Provide Excellent Liver Grafts for Transplantation

Darius, Tom; Monbaliu, Diethard; Jochmans, Ina; Meurisse, Nicolas; Desschans, Bruno; Coosemans, Willy; Komuta, Mina; Roskams, Tania; Cassiman, David; Merwe, Schalk van der; Steenbergen, Werner Van; Verslype, Chris; Laleman, Wim; Aerts, Raymond; Nevens, Frederik; Pirenne, Jacques

doi:10.1016/j.transproceed.2012.09.076

Cited by 47 publications

(42 citation statements)

References 29 publications

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“…Long-term complications include reduced patient and graft survival, especially in HCV positive recipients, and ischemic type biliary lesions (ITBL) [14] . These grafts are extremely sensitive to hemodynamic instability, and an appropriate donor management is pivotal with adequate systemic blood (> 100 mmHg) and central venous pressures (> 10 cm H2O), a hematocrit > 25%, normal body temperature, and diuresis greater than 1 mL/kg per hour in order to avoid hypoperfusion and low oxygen support to the liver graft [15] . A rapid procurement technique with minimal organ manipulation and double perfusion (aortic and portal) should be preferred [15] .…”

Section: Agementioning

confidence: 99%

“…These grafts are extremely sensitive to hemodynamic instability, and an appropriate donor management is pivotal with adequate systemic blood (> 100 mmHg) and central venous pressures (> 10 cm H2O), a hematocrit > 25%, normal body temperature, and diuresis greater than 1 mL/kg per hour in order to avoid hypoperfusion and low oxygen support to the liver graft [15] . A rapid procurement technique with minimal organ manipulation and double perfusion (aortic and portal) should be preferred [15] . In order to minimize the ischemia/reperfusion injury (I/R), CIT should be as short as possible [14,15] .…”

Section: Agementioning

confidence: 99%

“…A rapid procurement technique with minimal organ manipulation and double perfusion (aortic and portal) should be preferred [15] . In order to minimize the ischemia/reperfusion injury (I/R), CIT should be as short as possible [14,15] . Many series using graft older than 70 years showed optimal results when CIT is shorter than 8 h, whilst a CIT > 12 h is associated with a twofold risk of graft failure [16] .…”

Section: Agementioning

confidence: 99%

“…Thus, procurement in distant hospitals should be carefully evaluated and allocation to more stable patients who can better tolerate some degree of organ dysfunction should be warranted [16,17] . Older liver grafts are preferentially allocated to low biochemical model for end-stage (MELD) score patients and HCVnegative recipients with hepatocarcinoma [5,15] .…”

Section: Agementioning

confidence: 99%

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Strategies to optimize the use of marginal donors in liver transplantation

Pezzati

Ghinolfi

Simone

et al. 2015

WJH

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Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors (ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.

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Section: Agementioning

confidence: 99%

Section: Agementioning

confidence: 99%

Section: Agementioning

confidence: 99%

Section: Agementioning

confidence: 99%

See 2 more Smart Citations

Strategies to optimize the use of marginal donors in liver transplantation

Pezzati

Ghinolfi

Simone

et al. 2015

WJH

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“…It was reported that short and mid-term survival following liver transplantation using deceased donors !70 years old can be excellent provided that there is adequate donor and recipient selection (4).…”

Section: Introductionmentioning

confidence: 99%

Successful Living Donor Liver Transplantation Between Septuagenarians

Kim

Lee

et al. 2015

American Journal of Transplantation

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We report a case of a 76-year-old female who underwent living donor right hepatectomy for her 75-year-old husband with recurrent hepatocellular carcinoma. With her voluntary decision, full medical and psychiatric assessment was performed. The operative time was 130 min in the donor and 399 min in the recipient. Both the donor and recipient had an uneventful recovery and were discharged on days 7 and 10, respectively with normal liver function. The couple has had no complication so far and is currently doing well in good health 26 months after living donor liver transplantation.

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Kidney and liver transplantation in the elderly

Sutherland

IJzermans

Forsythe

et al. 2016

Journal of British Surgery

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Background: Transplant surgery is facing a shortage of deceased donor organs. In response, the criteria for organ donation have been extended, and an increasing number of organs from older donors are being used. For recipients, the benefits of transplantation are great, and the growing ageing population has led to increasing numbers of elderly patients being accepted for transplantation. Methods:The literature was reviewed to investigate the impact of age of donors and recipients in abdominal organ transplantation, and to highlight aspects of the fine balance in donor and recipient selection and screening, as well as allocation policies fair to young and old alike.Results: Overall, kidney and liver transplantation from older deceased donors have good outcomes, but are not as good as those from younger donors. Careful donor selection based on risk indices, and potentially biomarkers, special allocation schemes to match elderly donors with elderly recipients, and vigorous recipient selection, allows good outcomes with increasing age of both donors and recipients. The results of live kidney donation have been excellent for donor and recipient, and there is a trend towards inclusion of older donors. Future strategies, including personalized immunosuppression for older recipients as well as machine preservation and reconditioning of donor organs, are promising ways to improve the outcome of transplantation between older donors and older recipients.Conclusion: Kidney and liver transplantation in the elderly is a clinical reality. Outcomes are good, but can be optimized by using strategies that modify donor risk factors and recipient co-morbidities, and personalized approaches to organ allocation and immunosuppression.

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Septuagenarian and Octogenarian Donors Provide Excellent Liver Grafts for Transplantation

Cited by 47 publications

References 29 publications

Strategies to optimize the use of marginal donors in liver transplantation

Strategies to optimize the use of marginal donors in liver transplantation

Successful Living Donor Liver Transplantation Between Septuagenarians

Kidney and liver transplantation in the elderly

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