title: Risk analysis of ischemic-type biliary lesions after liver transplant using octogenarian donors.
abstract: The use of octogenarian donors to increase the donor pool in liver transplantation (LT) is controversial because advanced donor age is associated with a higher risk of ischemic-type biliary lesions (ITBL). The aim of this study was to investigate retrospectively the role of a number of different pre-LT risk factors for ITBL in a selected population of recipients of octogenarian donor grafts. Between January 2003 and December 2013, 123 patients underwent transplantation at our institution with deceased donor grafts from donors of age ≥80 years. Patients were divided into 2 groups based on the presence of ITBL in the posttransplant course. Exclusion criteria were retransplantations, presence of vascular complications, and no availability of procurement liver biopsy. A total of 88 primary LTs were included, 73 (83.0%) with no posttransplant ITBLs and 15 (17.0%) with ITBLs. The median follow-up after LT was 2.1 years (range, 0.7-5.4 years). At multivariate analysis, donor hemodynamic instability (hazard ratio [HR], 7.6; P = 0.005), donor diabetes mellitus (HR, 9.5; P = 0.009), and donor age-Model for End-Stage Liver Disease (HR, 1.0; P = 0.04) were risk factors for ITBL. Transplantation of liver grafts from donors of age ≥80 years is associated with a higher risk for ITBL. However, favorable results can be achieved with accurate donor selection. Donor hemodynamic instability, a donor history of diabetes mellitus, and allocation to higher Model for End-Stage Liver Disease score recipient all increase the risk of ITBL and are associated with worse graft survival when octogenarian donors are used. Liver Transplantation 22 588-598 2016 AASLD.
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Ghinolfi
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Simone
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pezzati
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Coletti
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Balzano
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Arenga
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Carrai
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Grande
authors.affiliation: Department of Pathology, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pollina
authors.affiliation: Department of Pathology, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Campani
authors.affiliation: Post-transplant Intensive Care Unit, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Biancofiore
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D001659:Biliary Tract / Q000293:injuries* / Q000473:pathology; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006439:Hemodynamics; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome