The use of old donors in liver transplantation

Dasari, B.; Schlegel, Andrea; Mergental, Hynek; Perera, M Thamara P R

doi:10.1016/j.bpg.2017.03.002

Cited by 36 publications

(68 citation statements)

References 61 publications

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“…In Korea, we need more data to validate the age criteria (≤ 40 years old for a SLT donor), ie, if there is a good liver with sufficient volume for SLT, but the donor age is more than 40 years, can we consider this donor for SLT? Using feasibility data of older donor livers (including age > 60 years) along with development of perfusion technology, we can expand the donor pool of SLTs by relaxing the age criteria and strengthening the volume‐matching criteria, because recipients have short ischemia times in Korea. The ROC analysis of donor age suggested a cutoff of 20 years.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Split Compared With Whole Liver Transplantation

et al. 2018

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Split-liver transplantation (SLT) should be cautiously considered because the right trisection (RTS) graft can be a marginal graft in adult recipients. Herein, we analyzed the outcomes of RTS-SLT in Korea, where >75% of adult liver transplantations are performed with living donor liver transplantation. Among 2462 patients who underwent deceased donor liver transplantations (DDLTs) from 2005 to 2014, we retrospectively reviewed 86 (3.5%) adult patients who received a RTS graft (RTS-SLT group). The outcomes of the RTS-SLT group were compared with those of 303 recipients of whole liver (WL; WL-DDLT group). Recipient age, laboratory Model for End-Stage-Liver Disease (L-MELD) score, ischemia time, and donor-to-recipient weight ratio (DRWR) were not different between the 2 groups (P > 0.05). However, malignancy was uncommon (4.7% versus 36.3%), and the donor was younger (25.2 versus 42.7 years) in the RST-SLT group than in the WL-DDLT group (P < 0.05). The technical complication rates and the 5-year graft survival rates (89.0% versus 92.8%) were not different between the 2 groups (P > 0.05). The 5-year overall survival (OS) rate (63.1%) and graft-failure-free survival rate (63.1%) of the RTS-SLT group were worse than that of the WL-DDLT group (79.3% and 79.3%; P < 0.05). The factors affecting graft survival rates were not definite. However, the factors affecting OS in the RTS-SLT group were L-MELD score >30 and DRWR ≤1.0. In the subgroup analysis, OS was not different between the 2 groups if the DRWR was >1.0, regardless of the L-MELD score (P > 0.05). In conclusion, a sufficient volume of the graft estimated from DRWR-matching could lead to better outcomes of adult SLTs with a RTS graft, even in patients with high L-MELD scores.

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Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Split Compared With Whole Liver Transplantation

et al. 2018

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“…The use of old donors in liver transplantation (LT) provides encouraging results and is expanding worldwide . Nevertheless, this practice is not universally implemented , due to concerns about a higher risk for primary non‐function (PNF), delayed graft function (DGF) , and worse long‐term graft survival .…”

Section: Introductionmentioning

confidence: 99%

Dual aortic and portal perfusion at procurement prevents ischaemic-type biliary lesions in liver transplantation when using octogenarian donors: a retrospective cohort study

et al. 2018

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Several risk factors for ischaemic-type biliary lesions (ITBL) after liver transplantation (LT) have been identified, but the role of portal vein perfusion at graft procurement is still unclear. This was a prospective study on double aortic and portal perfusion (DP) of liver grafts stratified by donor's decade (<60 yo; 60-69 yo; 70-79 yo and ≥80 yo) versus similar historical cohorts of primary, adult grafts procured with single aortic perfusion (SP) only. The primary study aim was to assess the role of DP on the incidence of ITBL. There was no difference in the incidence of overall biliary complications according to procurement technique for recipients of grafts <80 years. A higher incidence of ITBL was observed for patients receiving grafts ≥80 years and perfused through the aorta only (1.9 vs. 13.4%; P = 0.008). When analysing octogenarian grafts, donor male gender (HR = 6.4; P = 0.001), haemodynamic instability (HR = 4.9; P = 0.008), and type-2 diabetes mellitus (DM2) (HR = 3.0; P = 0.03) were all independent risk factors for ITBL, while double perfusion at procurement (HR = 0.1; P = 0.04) and longer donor intensive care unit (ICU) stay (HR = 0.7; P = 0.04) were protective factors. Dual aortic and portal perfusion has the potential to reduce post-transplant ITBL incidence for recipients of octogenarian donor grafts. Larger series are needed to confirm this preliminary experience.

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“…The use of very old donors in liver transplantation (LT) is showing favorable results, but this practice is not universally implemented because of concerns about a higher risk for primary nonfunction (PNF), delayed graft function (DGF), and worse longterm graft survival . In our recent series of octogenarian donors, we reported favorable overall longterm results, and we found that hepatitis C virus (HCV) recurrence and ischemic‐type biliary lesions (ITBLs) were 2 independent causes of graft loss in this population .…”

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confidence: 98%

Pilot, Open, Randomized, Prospective Trial for Normothermic Machine Perfusion Evaluation in Liver Transplantation From Older Donors

Ghinolfi

Rreka

Tata³

et al. 2019

Liver Transpl

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Ex situ normothermic machine perfusion (NMP) might minimize ischemia/reperfusion injury (IRI) of liver grafts. In this study, 20 primary liver transplantation recipients of older grafts (≥70 years) were randomized 1:1 to NMP or cold storage (CS) groups. The primary study endpoint was to evaluate graft and patient survival at 6 months posttransplantation. The secondary endpoint was to evaluate liver and bile duct biopsies; IRI by means of peak transaminases within 7 days after surgery; and incidence of biliary complications at month 6. Liver and bile duct biopsies were collected at bench surgery, end of ex situ NMP, and end of transplant surgery. Interleukin (IL) 6, IL10, and tumor necrosis factor α (TNF-α) perfusate concentrations were tested during NMP. All grafts were successfully transplanted. Median (interquartile range) posttransplant aspartate aminotransferase peak was 709 (371-1575) IU/L for NMP and 574 (377-1162) IU/L for CS (P = 0.597). There was 1 hepatic artery thrombosis in the NMP group and 1 death in the CS group. In NMP, we observed high TNF-α perfusate levels, and these were inversely correlated with lactate (P < 0.001). Electron microscopy showed decreased mitochondrial volume density and steatosis and an increased volume density of autophagic vacuoles at the end of transplantation in NMP versus CS patients (P < 0.001). Use of NMP with older liver grafts is associated with histological evidence of reduced IRI, although the clinical benefit remains to be demonstrated. The use of very old donors in liver transplantation (LT)is showing favorable results, (1) but this practice is not universally implemented (2) because of concerns about a higher risk for primary nonfunction (PNF), delayed graft function (DGF), (3) and worse longterm graft survival. (4) In our recent series of octogenarian donors, we reported favorable overall longterm results, and we found that hepatitis C virus (HCV) recurrence and ischemic-type biliary lesions (ITBLs) were 2 independent causes of graft loss in this population. (5) Although availability of direct antiviral agents is reducing the impact of donor age on HCV recurrence, (6) prevention of ischemia/reperfusion injury (IRI) is pivotal to the practice of elderly donor LT and for donation after circulatory death (DCD) donors. (7,8) Even though the concept of the ideal donor is well defined, (4,9) the definition of extended criteria donors remains controversial. Increased donor age contributes to a higher risk ghinOlfi et al.

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The use of old donors in liver transplantation

Cited by 36 publications

References 61 publications

Survival Outcomes in Split Compared With Whole Liver Transplantation

Survival Outcomes in Split Compared With Whole Liver Transplantation

Dual aortic and portal perfusion at procurement prevents ischaemic-type biliary lesions in liver transplantation when using octogenarian donors: a retrospective cohort study

Pilot, Open, Randomized, Prospective Trial for Normothermic Machine Perfusion Evaluation in Liver Transplantation From Older Donors

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