Association between donor age and risk of graft failure after liver transplantation: an analysis of the Eurotransplant database

Abstract

Summary Grafts from elderly donors are increasingly used for liver transplantation. As of yet there is no published systematic data to guide the use of specific age cutoffs the effect of elderly donors on patient outcomes must be clarified. This study analyzed the Eurotransplant database (01/01/2000–31/07/2014; N = 26 294) out of whom 8341 liver transplantations were filtered to identify for this analysis. 2162 of the grafts came from donors >60 including 203 from octogenarians ≥80 years. Primary outcome was the risk of graft failure according to donor age using a confounder adjusted Cox‐Regression model with frailty terms (or random effects). The proportion of elderly grafts increased during the study period [i.e., octogenarians 0.1% (n = 1) in 2000 to 3.4% (n = 45) in 2013]. Kaplan–Meier and Cox‐analyses revealed a reduced survival and a higher risk for graft failure with increasing donor age. Although the age effect was allowed to vary non‐linearly, a linear association hazard ratio (HR = 1.1 for a 10 year increase in donor age) was evident. The linearity of the association suggests that there is no particular age at which the effect increases more rapidly, providing no evidence for a cutoff age. In clinical practice, the combination of high donor age with HU‐transplantations, hepatitis C, high MELD‐scores and long cold ischemic time should be avoided.

The Differential Influence of Cold Ischemia Time on Outcome After Liver Transplantation for Different Indications—Who Is at Risk? A Collaborative Transplant Study Report

“…After prolonged cold ischemia, outcome of a graft depends on its ability to recover from the ischemia injury, which appears to be especially difficult in steatotic grafts or grafts from older donors (12)(13)(14). CIT influenced graft and patient survival in a linear fashion and only during the first year after transplantation.…”

Liver Grafts with Major Extended Donor Criteria May Expand the Organ Pool for Patients with Hepatocellular Carcinoma

“…The mean age of liver donors is increasing worldwide, despite evidence that advanced donor age impacts early mortality after transplantation, mainly because of increased cellular senescence and reduced regeneration of hepatocytes [3,28,29]. The liver parenchyma is more vulnerable to ischemia-reperfusion injury and inflammatory cytokine responses before and after transplantation [29,30].…”

“…Nagai et al reported twofold increased risk of hazard for CIT longer than 10 h and median time to HCC recurrence of 0.9 years [37]. After an extended CIT, graft outcome depends on the ability of the transplanted liver to recover from ischemia, which might be difficult in grafts from older donors [28,29,30,38]. Consequently, organs with longer CIT are often discarded because they are considered unsuitable for transplantation.…”

Reply to “Association between donor age and risk of graft failure after liver transplantation: an analysis of the Eurotransplant database”

“…We read with great interest the study by Pratschke et al [1] "Association between donor age and risk of graft failure after liver transplantation: An analysis of the Eurotransplant database." The study analyzed a large dataset from Eurotransplant and included a final sample of 8351 patients undergoing liver transplantation between January 2000 and July 2014, of whom 252 (3.0%) were transplanted with octogenarian, brain-dead donor grafts.…”