The Impact of Donor Age on Liver Transplantation: Influence of Donor Age on Early Liver Function and on Subsequent Patient and Graft Survival

Busquets, Juli; Xiol, Xavier; Figueras, Juan; Jaurrieta, Eduardo; Torras, Jaume; Ramos, Emilio; Rafecas, A; Fabregat, J.; Lama, Carmen; Ibáñez, Luis; Lladó, Laura; Ramón, José

doi:10.1097/00007890-200106270-00011

Cited by 154 publications

(101 citation statements)

References 22 publications

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“…2,[15][16][17][18][19] This incidence is similar to the one observed for our SAP group. It is worth emphasizing that the prevalence of PNF, and consequently of graft/patient losses in the SAP group, are probably overestimated due to the small sample size.…”

Section: Discussionsupporting

confidence: 90%

“…2 On these grounds, we defined suboptimal livers as those with 1 major negative factor and/or at least 2 minor factors. This definition, based on several studies published in recent years, 2,[6][7][8][9][10][11][16][17][18][19][20] revealed a statistically significant impact on post-LT graft and patient survival rates in a retrospective analysis of our last 400 cases (our unpublished data).…”

Section: Discussionmentioning

confidence: 78%

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Liver transplantation using suboptimal grafts: Impact of donor harvesting technique

et al. 2007

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In recent years, an increasing number of suboptimal grafts has been used to reduce the gap between the supply and demand of organs for liver transplantation (LT). In this randomized prospective study, we tested the impact of donor harvesting technique on the posttransplantation outcome of suboptimal donor livers. A modified double perfusion (MDP) technique (aortic and portal cooling with tourniquet clamping of splenomesenteric vein inflow) was compared with the single aortic perfusion (SAP) technique. Between February and November 2005, 35 suboptimal grafts were randomly assigned to either technique (18 MDP livers and 17 SAP livers). Donor and recipient variables were comparable in the 2 study groups. The SAP group had significantly higher blood transaminases and bilirubin levels after LT. The prevalence of graft primary dysfunction (PDF) was also significantly higher (P ϭ 0.01) in the SAP group (35%) than in the MDP group (5%). In 5 cases, all in the SAP group (P ϭ 0.02), early re-LT (Ͻ30 days) was needed. The 6-month patient and graft survival rates were significantly higher in the MDP (100% in both cases) than in the SAP group (68% and 58%, respectively). The study was stopped in November 2005, when the interim analysis revealed such markedly significant differences between the two groups. In conclusion, the present study showed a very low prevalence of PDF, death, and re-LT after transplantation with suboptimal liver when a MDP technique was used to harvest the donor graft.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 78%

Liver transplantation using suboptimal grafts: Impact of donor harvesting technique

et al. 2007

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“…This observation supports recent reports from European and American series that advanced donor age negatively impacts on graft and patient survival among HCV-infected liver transplant recipients. [11][12][13] This is in contrast to patients who received a liver transplant for non-HCV related end-stage liver disease where donor age appeared not to affect prognosis. 11 Therefore, it is apparent that similar to the pretransplant setting, age at the time of HCV infection acquisition is an important determinate of disease progression; however, it is not entirely clear the mechanisms by which donor age contribute to graft injury.…”

Section: Discussionmentioning

confidence: 90%

“…3,10 Recently, advanced donor age has been recognized to adversely influence the posttransplant course among HCV liver transplant recipients. [11][12][13] In Australia and New Zealand, the HCV-infected cohort of patients tend to come from a heterogeneous ethnic background. This offers a unique opportunity to analyze predictors of outcome in a population of HCV liver transplant recipients, with a diverse mode of HCV acquisition and a broad genotype distribution.…”

Section: H Epatitis C Virus (Hcv)-related Liver Disease Is Amentioning

confidence: 99%

Liver transplantation for HCV-associated liver cirrhosis: Predictors of outcomes in a population with significant genotype 3 and 4 distribution

Zekry

Whiting

Crawford

et al. 2003

Liver Transplantation

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End-stage liver disease associated with hepatitis C virus (HCV) infection is now the leading indication for liver transplantation in adults. However, reinfection of the graft is universal. We aimed to determine predictors of outcome of HCV-liver transplant recipients in the Australian and New Zealand communities. The following variables were analysed: demographic factors, coexistent pathology at the time of transplantation, HCV genotype, and donor age. Outcomes measures were: 1. mortality; 2. development of HCV-related complications, which were stage 3 or 4 fibrosis, or mortality from HCV-related graft failure, or both. Between January 1989 and December 30, 1999, 182 patients were transplanted for HCV-associated cirrhosis. The median follow-up period was 4 years (range, 0 to 13 years). Genotype data were available on 157 patients. The distribution of genotypes among the 157 patients was as follows: 36 (23%) genotype 1a, 30 (19%) genotype 1b, 4 (9%) genotype 1, 17 (11%) genotype 2, 41 (26%) genotype 3a, and 16 (10%) genotype 4. Eight (5%) patients were HCV-polymerase chain reaction (PCR)-negative (but HCV-antibody-positive). Donor age and genotype 4 were associated with an increased risk of retransplantation or death (P < .001 and .05, respectively). Meanwhile, donor age, genotype 4, and pretransplant excess alcohol were risk factors for the development of HCV-related complications (P ‫؍‬ .004, .008, and .02, respectively). In contrast, patients with genotype 3a were less likely to develop HCV-related complications (P ‫؍‬ .05). In a population of HCV liver transplant recipients with a heterogeneous genotype distribution, donor age, and genotype 4, were predictors of a worse outcome, whereas genotype 3 was associated with a more favorable outcome. (Liver Transpl 2003;9:339-347.)

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“…Donor age of more than 70 years, however, was found to be associated with lower patient and graft survival. 13 In contrast to other organs, the liver may be more immune to senescence, particularly in the otherwise healthy person. This is possibly because of the liver's large functional reserve, regenerative capacity, and dual blood supply, which exceeds its metabolic needs.…”

Section: Donor Agementioning

confidence: 99%

The utility of marginal donors in liver transplantation

Busuttil¹

2003

Liver Transplantation

629

508

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The shortage of organs has led centers to expand their criteria for the acceptance of marginal donors. The combination of multiple marginal factors seems to be additive on graft injury. In this review, the utility of various marginal donors in patients requiring liver transplantation will be described, including older donors, steatotic livers, non-heart-beating donors, donors with viral hepatitis, and donors with malignancies. The pathophysiology of the marginal donor will be discussed, along with strategies for minimizing the ischemia reperfusion injury experienced by these organs. Finally, new strategies for improving the function of the marginal/expanded donor liver will be reviewed. (Liver Transpl 2003;9:651-663.)

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The Impact of Donor Age on Liver Transplantation: Influence of Donor Age on Early Liver Function and on Subsequent Patient and Graft Survival

Abstract: Advanced donor age is associated with lower graft and recipient survival.

Cited by 154 publications

References 22 publications

Liver transplantation using suboptimal grafts: Impact of donor harvesting technique

Liver transplantation using suboptimal grafts: Impact of donor harvesting technique

Liver transplantation for HCV-associated liver cirrhosis: Predictors of outcomes in a population with significant genotype 3 and 4 distribution

The utility of marginal donors in liver transplantation

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