Improving the outcome of liver transplantation with very old donors with updated selection and management criteria.
Advanced donor age is a risk factor for poor outcome in liver transplantation (LT). We reviewed 553 consecutive transplants according to donor age categories [group 1 (n = 173): <50 years; group 2 (n = 96): 50-59 years; group 3 (n = 132): 60-69 years; group 4 (n = 111): 70-79 years; group 5 (n = 41): > or =80 years]. Clinical parameters were comparable between groups. Group 5 had the highest proportion of pretransplant liver biopsy (85%), with only 1 graft showing macrovesicular steatosis > 30%, and the lowest ischemia time. Five-year graft survival was significantly higher in group 1 (75%) versus groups 3 (60%) and 4 (62%; P = 0.01 and P = 0.001, respectively) and in group 5 (81%) versus groups 3 and 4 (P = 0.04 and P = 0.01, respectively). Donor age of 60-79 years, recipient hepatitis C virus-positive status, Model for End-Stage Liver Disease score > or = 25, and emergency LT were predictors of poor survival. In hepatitis C virus-positive patients, 5-year graft survival was 72% in group 1, 85% in group 2, 52% in group 3, 65% in group 4, and 71% in group 5 (group 1 versus group 3, P = 0.04; group 2 versus group 3, P = 0.03). In conclusion, older donor grafts managed with routine graft biopsy and short ischemia time may work effectively, regardless of the severity of the recipient's liver disease.
Cescon
Matteo
M
Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy. matteo.cescon@aosp.bo.it
Grazi
Gian Luca
GL
Cucchetti
Alessandro
A
Ravaioli
Matteo
M
Ercolani
Giorgio
G
Vivarelli
Marco
M
D'Errico
Antonietta
A
Del Gaudio
Massimo
M
Pinna
Antonio Daniele
AD
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D050377:Cold Ischemia; D004638:Emergency Treatment; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D052096:Warm Ischemia