Liver transplantations with donors aged 60 years and above: the low liver damage strategy.
According to transplant registries, grafts from elderly donors have lower survival rates. During 1999-2005, we evaluated the outcomes of 89 patients who received a liver from a donor aged > or = 60 years and managed with the low liver-damage strategy (LLDS), based on the preoperative donor liver biopsy and the shortest possible ischemia time (group D > or = 60-LLDS). Group D > or = 60-LLDS was compared with 198 matched recipients, whose grafts were not managed with this strategy (89 donors < 60 years, group D < 60-no-LLDS and 89 donors aged > or =60 years, group D > or = 60-no-LLDS). In the donors proposed from the age group of > or =60 years, the number of donors rejected decreased during the study period and the LLDS was found to be responsible for this in a significant manner (47% vs. 60%, respectively P < 0.01). Among the recipients transplanted, the clinical features (age, gender, viral infection, child and model for end-stage liver disease score) were comparable among groups, but group D > or = 60-LLDS had a lower mean ischemia time: 415 +/- 106 min vs. 465 +/- 111 (D < 60-no-LLDS), P < 0.05 and vs. 476 +/- 94 (D > or = 60-no-LLDS), P < 0.05. After a median follow-up of 3 years, the 1- and 3-year graft survival rates of group D > or = 60-LLDS (84% and 76%) were comparable with group D < 60-no-LLDS (89% and 76%) and were significantly higher than group D > or = 60-no-LLDS (71% and 54%), P < 0.005. In conclusion, the LLDS optimized the use of livers from elderly donors.
Ravaioli
Matteo
M
Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. mrava1@hotmail.com
Grazi
Gian Luca
GL
Cescon
Matteo
M
Cucchetti
Alessandro
A
Ercolani
Giorgio
G
Fiorentino
Michelangelo
M
Panzini
Ilaria
I
Vivarelli
Marco
M
Ramacciato
Giovanni
G
Del Gaudio
Massimo
M
Vetrone
Gaetano
G
Zanello
Matteo
M
Dazzi
Alessandro
A
Zanfi
Chiara
C
Di Gioia
Paolo
P
Bertuzzo
Valentina
V
Lauro
Augusto
A
Morelli
Cristina
C
Pinna
Antonio Daniele
AD
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome