Impact of donor age in liver transplantation from donation after circulatory death donors: A decade of experience at Cleveland Clinic.
The use of liver grafts from donation after circulatory death (DCD) donors remains controversial, particularly with donors of advanced age. This retrospective study investigated the impact of donor age in DCD liver transplantation. We examined 92 recipients who received DCD grafts and 92 matched recipients who received donation after brain death (DBD) grafts at Cleveland Clinic from January 2005 to June 2014. DCD grafts met stringent criteria to minimize risk factors in both donors and recipients. The 1-, 3-, and 5-year graft survival in DCD recipients was significantly inferior to that in DBD recipients (82%, 71%, 66% versus 92%, 87%, 85%, respectively; P = 0.03). Six DCD recipients (7%), but no DBD recipients, experienced ischemic-type biliary stricture (P = 0.01). However, the incidence of biliary stricture was not associated with donor age (P = 0.57). Interestingly, recipients receiving DCD grafts from donors who were <45 years of age (n = 55) showed similar graft survival rates compared to those receiving DCD grafts from donors who were ≥45 years of age (n = 37; 80%, 69%, 66% versus 83%, 72%, 66%, respectively; P = 0.67). Cox proportional hazards modeling in all study populations (n = 184) revealed advanced donor age (P = 0.05) and the use of a DCD graft (P = 0.03) as unfavorable factors for graft survival. Logistic regression analysis showed that the risk of DBD graft failure increased with increasing age, but the risk of DCD graft failure did not increase with increasing age (P = 0.13). In conclusion, these data suggest that stringent donor and recipient selection may ameliorate the negative impact of donor age in DCD liver transplantation. DCD grafts should not be discarded because of donor age, per se, and could help expand the donor pool for liver transplantation.
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Daniel J
DJ
Firl
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Koji
K
Hashimoto
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Colin
C
O'Rourke
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Teresa
T
Diago-Uso
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Masato
M
Fujiki
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Federico N
FN
Aucejo
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Cristiano
C
Quintini
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Dympna M
DM
Kelly
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Charles M
CM
Miller
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
John J
JJ
Fung
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.|Department of General Surgery, Digestive Disease Institute, Cleveland, OH.
Bijan
B
Eghtesad
D000328:Adult; D000367:Age Factors; D001926:Brain Death; D003643:Death; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*