A Donor Age-Based and Graft Volume–Based Analysis for Living Donor Liver Transplantation in Elderly Recipients

Abstract

BackgroundGiven the expected increase in the number of elderly recipients, details regarding how clinical factors influence the outcome in living donor liver transplantation (LDLT) for the elderly remain unclear. We examined the survival outcomes according to the results of donor age-based and graft volume–based analyses and assessed the impact of prognostic factors on the survival after LDLT for elderly recipients.MethodsThe 198 adult recipients were classified into 2 groups: an elderly group (n = 70, E group; ≥ 60 years of age) and a younger group (n = 128, Y group; <60 years of age). We analyzed the prognostic factors for the survival in the E group and the survival rate for both groups at several follow-up points and conducted subgroup analyses in the E group by combining the donor age (≥50 vs <50 years) and graft weight (GW)/standard liver volume (SLV) (≥40% vs <40%).ResultsDonor age (hazard ratio [HR], 2.17; P = 0.062) and GW/SLV (HR, 1.80; P = 0.23) tended to have a high HR in the E group. The overall patient survival rates at 1, 3, and 5 years were 78.3%, 73.0%, and 61.0% in the E group, and 82.0%, 75.1%, and 69.2% in the Y group, respectively (P = 0.459). However, the outcomes tended to be worse in recipients of grafts from donors ≥50 years of age than in those with grafts from younger donors with GW/SLV < 40% (P = 0.048).ConclusionsA worse outcome might be associated with aging of the donor, which leads to impairment of the graft function and liver regeneration. Both the graft volume and donor age should be considered when choosing grafts for LDLT in elderly patients.

Older Donor Age Is a Risk Factor for Negative Outcomes After Adult Living Donor Liver Transplantation Using Small‐for‐Size Grafts

“…(29) Imamura et al reported that LDLT outcomes in elderly recipients with grafts from donors aged ≥50 years with graft weight/standard liver volume of <40% were significantly worse than those with other combinations of age and graft weight/standard liver volume. (30) The poor outcome with the older donor age group in our study may be attributed to the effect of aging on the liver's capacity for regeneration. (22) Hidaka et al have attributed that to the significantly fewer Kupffer cells in liver grafts donated from elderly donors than those procured from young donors.…”

“…Moon et al reported that ALDLT using a right lobe with GRWR <0.8% can be performed safely when grafts from young donors (<44 years old) are used and attention is paid to MHV tributary drainage . Imamura et al reported that LDLT outcomes in elderly recipients with grafts from donors aged ≥50 years with graft weight/standard liver volume of <40% were significantly worse than those with other combinations of age and graft weight/standard liver volume …”

Factors Affecting Liver Regeneration in Donors&apos; Grafts in Living Donor Liver Transplant (LDLT) a Center Experience

“…Regarding the impact of age on donor prognosis, it has been reported that the length of hospitalization of liver donors aged >50 years was longer compared with that of young donors; furthermore, the ability of postoperative protein synthesis is decreased, the duration of cholestasis is prolonged, TB levels increase significantly, and the incidence rate of postoperative complications is higher among older patients. And for recipients receiving an elderly donor liver, there is a significant increase in the risk of postoperative microvascular thrombosis [28,29,30]. In our study all of our donors were less than 40yrs and so no effect of age was found on the rate of regeneration.…”

Surgical Outcome and Hepatic Regeneration after Hepatic Resection for Hepatocellular Carcinoma in Elderly Patients

“…In particular, a few reports have found that it is now possible to perform hepatectomies safely even in elderly patients who have various complications [20][21][22]. However, there have only been a few studies of perioperative liver regeneration in elderly patients who undergo hepatectomies [23]. Therefore, we compared regeneration of the remnant liver and other aspects of the perioperative course in elderly and non-elderly patients.…”