The waiting list for liver transplantation has more than doubled between 1988 and 1992, yet the number of liver transplantations during the same period increased by only 79%. This discrepancy is due to the limited availability of donors. The modest increase in donor pool is caused entirely by donors 240 years of age, a trend likely to continue. To determine the impact of increasing donor age on the outcome of liver transplantation, we analyzed 6-month graft survival in 7,988 adults who received first liver graft between October 1987 and September 1992, and were observed through the United Network for Organ Sharing Scientific Liver Transplant Registry. Graft survival was measured by death and/or retransplantation, donor age by decades. The independent effect of donor age on graft survival was estimated by Cox regression analysis controlling for the possible confounding of donor, recipient, and institutional characteristics. Between 1987 and 1992, the perhe clinical success of liver transplantation has T been accompanied by an increased demand for organs. The availability of donors relative to this demand is becoming more and more limited. With an 8% to 9% waiting list mortality in years 1988 through 1992, and an increasing median waiting time from 1 to 3 months during the same period,' the risks known or presumed to be associated with the use of "marginal" donors often may be preferred over the prospect of an unpredictably long wait for a "suitable" organ. Attempts to expand the donor pool through the relaxation of donor age criteria have been characterized by added efforts on the part of transplantation teams to verify the quality of older grafts,l and the early experience from these transplantations suggests that, in the absence of other risk parameters, organs from older donors can provide a valuable relief to the current organ shortage. Even though according to some studies3 early liver function appears to be affected by donor age, some transplantation teams have reported no difference in survival rates for liver transplantations using older donor^.^-^ However, there is not an absolute consensus on the clinical equivalence between livers from old and centage of donors over 50 years increased from 2.1% to 17.5% resulting in change of median donor age from 23 to 31 years. For donor age 250, graft failure rate was 50% higher than with donor age less than 20 years (excess for mortality was 25% and for retransplantation 94%). Adjustment for characteristics associated to donor age or outcome did not eliminate the excess risk found with increasing donor age. Despite these adversities, graft failure rate in recipients from oldest donors (27.2%) in 1992 was nearly equivalent to recipients from the youngest donors (26.9%) in 1987 to 1988. Although increasing donor age has an adverse effect on 6-month graft survival, improvement in transplantation technology and patient care over time have more than compensated for poorer graft function associated with the simultaneous rise in median donor age.Copyright o 7995 by the A...
For several medical interventions, increasing experience results in improved outcome. This finding may result from better patient selection or increased skill levels. This report examines whether there is a relationship between center experience and patient outcome for liver transplantation, and if so, whether the relationship is explained by patient or donor selection or level of experience required to obtain optimal results. The United Network for Organ Sharing Scientific Liver Transplant Registry includes all procedures performed in the United States since October 1987. The date of the first transplantation and the number of operations performed were used to define 42 new and 27 experienced centers. Within new centers, experience was quantified by the sequence number of each transplantation. Characteristics of 6,180 recipients and donors were compared between new and experienced centers using the χ2 test for association. A linear trend test identified whether these characteristics varied with experience within new centers. The independent association between experience in new centers and perioperative mortality was examined using logistic regression. Patient and donor selection criteria differ between experienced and new centers and change within new centers as experience is gained. Adjusting for calendar year and various patient and donor characteristics, perioperative mortality rates decrease in new centers as experience is gained. After 20 transplantations are performed, perioperative mortality in new centers is not significantly different than that in experienced centers. Criteria for recipient and donor selection change as centers gain experience. Despite these differences and improvements that have occurred over time, increasing experience in centers performing liver transplantations is associated with reduced perioperative mortality.
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