Comparable graft survival is achievable with the usage of donation after circulatory death liver grafts from donors at or above 70 years of age: A long-term UK national analysis

Abstract

The aim of the study was to assess the UK donation after circulatory death (DCD) liver transplant experience from donors ≥70 years. Nationwide UK DCD retrospective analysis was conducted between 2001 and 2015 (n = 1163). Recipients were divided into group 1 vs. group 2 (donors 70≥ vs. <70 years, respectively). group 1 (n = 69, 5.9%) recipients were older (median 59 vs. 55 years, p = .001) and had longer waitlist time (128 vs. 84 days; p = .039). 94.2% of group 1 clustered in London and Birmingham, where the two busiest centers are located. group 1 allografts had higher UKDRI and UK DCD Risk Scores but similar WIT and CIT and were more likely to have been imported. Both groups had similar 1‐, 3‐, and 5‐year graft survival (group 1, 90%, 81.4%, and 74% vs. group 2, 88.6%, 81.4%, and 78.6%, respectively; p = .54). Both groups had similar ICU stay length (p = .22), 3‐month hepatic artery thrombosis rates (4.4% vs 4.0%; p = .9), and 12‐month readmission rates for all biliary complications (20.3% vs 25.7%; p = .32). This study demonstrates that acceptable outcomes are achievable using older grafts in a highly selected cohort at experienced centers. Advanced age should not be an absolute contraindication to utilizing a DCD graft from donors aged ≥70 years.

A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

“…With recent cohort analyses, donor age as individual risk factor had no impact on outcome after DCD liver transplantation (beyond 60 or 70years), given other risk parameters are kept low [42,45]. Donor age was therefore not selected as limiting parameter to identify the benchmark cohort, also because the median donor age of our entire cohort was only 48years with a 75 th -percentile of 58years [42,43].…”

Normothermic Machine Perfusion—Improving the Supply of Transplantable Livers for High-Risk Recipients

“…The threshold for considering a donor to be of advanced age varies considerably, ranging from ≥40 to ≥80 years of age ( 54 – 56 ). Recent evidence demonstrates that elderly donors of DCD (>70 years) and DBD (>80 years) grafts can be used safely with 5 years graft survival rates of 74% and 77%, respectively, and therefore advanced age should not be a contraindication ( 54 , 57 ).…”

“…The threshold for considering a donor to be of advanced age varies considerably, ranging from ≥40 to ≥80 years of age ( 54 – 56 ). Recent evidence demonstrates that elderly donors of DCD (>70 years) and DBD (>80 years) grafts can be used safely with 5 years graft survival rates of 74% and 77%, respectively, and therefore advanced age should not be a contraindication ( 54 , 57 ). Grafts from older donors should be viewed as more susceptible to cold preservation injury for the aforementioned reason, therefore every effort should be made to minimize the CIT and NMP is an ideal strategy.…”

Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper

“… 65 Current outcomes of DCDD and DNDD liver transplantation are very similar, with 85–95% and 70–85% 1- and 5-year patient and graft survival, respectively, albeit with a higher risk of late re-transplantation in DCDD recipients. 66 – 69 Modern perfusion and preservation techniques have reduced the risks of primary non-function and biliary complications. The technique of trans-arterial normothermic regional perfusion using a portable ECMO device permits early blood perfusion and oxygenation, resulting in mitochondrial replenishment before SCS.…”