title: Liver transplantation using elderly donors: a risk factor analysis.
abstract: Survival after liver transplantation is negatively impacted by use of elderly deceased donors, but excluding them would increase waiting times and waiting list mortality. We reviewed our experience with liver transplantation (LT) utilizing livers from deceased donors 65 yr of age and older to identify those factors that impact graft survival. All adult patients (≥ 18 yr old) who underwent primary LT using deceased donor livers from donors aged ≥ 65 yr between February 1995 and November 2003 were included. With multivariate analysis we found four unfavorable characteristics significantly associated with higher post-transplant graft failure rate. These characteristics are hepatitis C as an etiology of liver disease, Model for End-Stage Liver Disease score >20, serum glucose level of donor > 200 mg/dL at the time of liver recovery, and skin incision to aortic cross-clamp time > 40 minutes in the donor surgery. The five-yr estimated graft survival rates having 0, 1, 2, 3, and 4 unfavorable characteristics were 100%, 82.0%, 81.7%, 39.3%, and 25.0%, respectively (p < 0.05). Our data demonstrated good graft survival can be achieved in LT using elderly donor liver allografts with appropriate patient selection, donor blood glucose management and efficient liver recovery with minimal manipulation of the liver during donor surgery.
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Dae Y
authors.initials: DY
authors.lastname: Kim
authors.forename: Jang
authors.initials: J
authors.lastname: Moon
authors.forename: Eddie R
authors.initials: ER
authors.lastname: Island
authors.forename: Akin
authors.initials: A
authors.lastname: Tekin
authors.forename: Susan
authors.initials: S
authors.lastname: Ganz
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult