Effects of Donor Age and Cold Ischemia on Liver Transplantation  Outcomes According to the Severity of Recipient Status.
BackgroundProlonged cold ischemic time (CIT) and increased donor age are well-known factors negatively influencing outcomes after liver transplantation (LT).


OBJECTIVE
The aim of this study was to evaluate whether the magnitude of their negative effects is related to recipient model for end-stage liver disease (MELD) score.


METHODS
This retrospective study was based on a cohort of 1402 LTs, divided into those performed in low-MELD (<10), moderate-MELD (10–20), and high-MELD (>20) recipients.


RESULTS
While neither donor age (p = 0.775) nor CIT (p = 0.561) was a significant risk factor for worse 5-year graft survival in low-MELD recipients, both were found to yield independent effects (p = 0.003 and p = 0.012, respectively) in moderate-MELD recipients, and only CIT (p = 0.004) in high-MELD recipients. However, increased donor age only triggered the negative effect of CIT in moderate-MELD recipients, which was limited to grafts recovered from donors aged ≥46 years (p = 0.019). Notably, utilization of grafts from donors aged ≥46 years with CIT ≥9 h in moderate-MELD recipients (p = 0.003) and those with CIT ≥9 h irrespective of donor age in high-MELD recipients (p = 0.031) was associated with particularly compromised outcomes.


CONCLUSIONS
In conclusion, the negative effects of prolonged CIT seem to be limited to patients with moderate MELD receiving organs procured from older donors and to high-MELD recipients, irrespective of donor age. Varying effects of donor age and CIT according to recipient MELD score should be considered during the allocation process in order to avoid high-risk matches.
Michał
M
Grąt
Karolina M
KM
Wronka
Waldemar
W
Patkowski
Jan
J
Stypułkowski
Karolina
K
Grąt
Maciej
M
Krasnodębski
Łukasz
Ł
Masior
Zbigniew
Z
Lewandowski
Marek
M
Krawczyk
D000328:Adult; D000375:Aging; D050377:Cold Ischemia / Q000009:adverse effects*; D058625:End Stage Liver Disease / Q000145:classification* / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome