Systematic review and meta‐analysis of liver transplantation using grafts from deceased donors aged over 70 years

Dasari, B.; Mergental, Hynek; Isaac, John; Muiesan, Paolo; Mirza, Darius F.; Perera, Thamara

doi:10.1111/ctr.13139

Cited by 23 publications

(22 citation statements)

References 30 publications

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“…The reported incidence of HAT lies between 1.6% and 4% in adult recipients 101,102,283 . Two patients (3,7%) both in the D75 group and the control group experienced HAT or stenosis, which is in line with other recent studies showing no increased occurrence of arterial complications in grafts from older compared to younger donors 203,205,206,273,274 .…”

Section: Vascular Complicationssupporting

confidence: 90%

“…However, we did not experience any incidents of PNF, neither in the D75 group nor in the control group. Furthermore, multiple recent studies have not revealed any difference in PNF between old and younger donors 201,203,205,206,273,274 , illustrating that in cases where PNF occurs, it is probably not directly related to the age of the liver graft.…”

Section: Primary Nonfunctionmentioning

confidence: 92%

“…In 15 of these 16 patients the biliary complications derived from the common bile duct. Earlier studies on the use of old liver donors have raised concerns regarding increased risk for biliary complications, but the available data are conflicting as some studies show increased risk while other reports do not show any association 177,178,205,206,273,278,279 . Some studies have highlighted that old donor age is an independent risk factor for ischemic-type biliary lesions (ITBL) with incidence ranging from 4% to 25% 178,279 .…”

Section: Biliary Complicationsmentioning

confidence: 99%

“…patients receiving grafts from donors above 70 years, not different from a corresponding 71% for those with donors below 70205 . Also in 2017, Dasari et al published a review and meta-analysis including 8 studies with a total of 879 patients with donors above 70 years273 . Results were compared to recipients of donor livers less than 70 years.…”

mentioning

confidence: 99%

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Transplantation With Livers From Deceased Donors Older Than 75 Years

et al. 2015

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Section: Vascular Complicationssupporting

confidence: 90%

Section: Primary Nonfunctionmentioning

confidence: 92%

Section: Biliary Complicationsmentioning

confidence: 99%

mentioning

confidence: 99%

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Transplantation With Livers From Deceased Donors Older Than 75 Years

et al. 2015

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“…The presented results of outcomes after transplantation with a liver from an older donor are in accordance with results from other regions, although these are reported with a high variance. Reported patient survival rates at 1 year vary from 70% to 90% and 5‐year patient survival rates from 50% to 80% . The sometimes very promising outcomes are apparently contradicting to the higher intrinsic risk of older donors .…”

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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Safety and Benefit of Using Liver Grafts From Older Donors

2019

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In Reply We appreciate the interest in our study 1 expressed by Gachabayov et al, and we welcome their comments. First, our study methodology indeed shares similarities with the before-after design as referred to. However, the current design remains that of a cohort study, given the fact that the cohort includes patients that all share the same characteristics (ie, patients 18 years or older undergoing elective laparoscopic colorectal cancer surgery) apart from the intervention (systematic video recording). 2 It is our belief that in the example of decreased length of hospital stays, sample size is a more substantial part to acknowledge. Therefore, regarding this outcome, we have suggested specifically to interpret this particular result discretely. Also, it has been reported that certain studies with intermediate quality of study design, eg, observational studies, are not inferior to studies with high quality, eg, randomized clinical trials, in the case of systematic overestimation of study effects. The main importance is that a single study, no matter the quality of design, should be interpreted cautiously in isolation of other results. 3 Concerning the Hawthorn effect, we purposely informed all participating surgeons to the study and provided the checklist referred to in the article requesting all to actively record the requested segments to investigate its impact on reporting quality. As stated in the article, we found no significant differences in reporting adequacy of systematic video recording vs narrative operative report (mean [SD], 52.5% [18.3%] vs 58.9% [19.9%]; P = .07). We therefore believe that the Hawthorn effect was negligible in this study.

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Systematic review and meta‐analysis of liver transplantation using grafts from deceased donors aged over 70 years

Abstract: Liver grafts from selected >70-year-old donors do not pose added organ-specific risks and thus have comparable transplantation outcomes.

Cited by 23 publications

References 30 publications

Transplantation With Livers From Deceased Donors Older Than 75 Years

Transplantation With Livers From Deceased Donors Older Than 75 Years

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

Safety and Benefit of Using Liver Grafts From Older Donors

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