Recipient age affects long-term outcome and hepatitis C recurrence in old donor livers following transplantation.
We studied the role of donor and recipient age in transplantation/ischemia-reperfusion injury (TIRI) and short- and long-term graft and patient survival. Eight hundred twenty-two patients underwent deceased donor liver transplantation, with 197 donors being > or = 60 years old. We evaluated markers of reperfusion injury, graft function, and clinical outcomes as well as short- and long-term graft and patient survival. Increased donor age was associated with more severe TIRI and decreased 3- and 5-year graft survival (73% versus 85% and 72% versus 81%, P < 0.001) and patient survival (77% versus 88% and 77% versus 82%, P < 0.003). Hepatitis C virus (HCV) infection and recipient age were the only independent risk factors for graft and patient survival in patients receiving an older graft. In the HCV(+) cohort (297 patients), patients > or = 50 years old who were transplanted with an older graft versus a younger graft had significantly decreased 3- and 5-year graft survival (68% versus 83% and 64% versus 83%, P < 0.009). In contrast, HCV(+) patients < 50 years old had similar 3- and 5-year graft survival if transplanted with either a young graft or an old graft (81% versus 82% and 81% versus 82%, P = 0.9). In conclusion, recipient age and HCV status affect the graft and patient survival of older livers. Combining older grafts with older recipients should be avoided, particularly in HCV(+) patients, whereas the effects of donor age can be minimized in younger recipients.
Division of Multiorgan Transplantation, Department of General Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
Markus
M
Selzner
Arash
A
Kashfi
Nazia
N
Selzner
Stuart
S
McCluskey
Paul D
PD
Greig
Mark S
MS
Cattral
Gary A
GA
Levy
Les
L
Lilly
Eberhard L
EL
Renner
George
G
Therapondos
Lesley E
LE
Adcock
David R
DR
Grant
Ian D
ID
McGilvray
D000367:Age Factors; D000368:Aged; D000375:Aging; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D017093:Liver Failure / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome