Does Matching Donor-Recipient Age Affect Long-Term Survival in Liver Transplantation?

Dopazo, Cristina; Bilbao, Itxarone; Castells, Lluı́s; Caralt, M.; Sevilla, Elena Fernández de; Lázaro, José; Charco, R.

doi:10.12659/aot.900767

Cited by 6 publications

(7 citation statements)

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“…In general, the descriptive data suggest a careful allocation of elderly grafts. Nevertheless, the present data could also promote an “old for old program” in liver transplantation which is supported by recent literature .…”

Section: Discussionsupporting

confidence: 89%

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

Pratschke

Bender²,

Boesch

et al. 2018

Transpl Int

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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.

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Section: Discussionsupporting

confidence: 89%

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

Pratschke

Bender²,

Boesch

et al. 2018

Transpl Int

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“…In Korea, we need more data to validate the age criteria (≤ 40 years old for a SLT donor), ie, if there is a good liver with sufficient volume for SLT, but the donor age is more than 40 years, can we consider this donor for SLT? Using feasibility data of older donor livers (including age > 60 years) along with development of perfusion technology, we can expand the donor pool of SLTs by relaxing the age criteria and strengthening the volume‐matching criteria, because recipients have short ischemia times in Korea. The ROC analysis of donor age suggested a cutoff of 20 years.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Split Compared With Whole Liver Transplantation

et al. 2018

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Split-liver transplantation (SLT) should be cautiously considered because the right trisection (RTS) graft can be a marginal graft in adult recipients. Herein, we analyzed the outcomes of RTS-SLT in Korea, where >75% of adult liver transplantations are performed with living donor liver transplantation. Among 2462 patients who underwent deceased donor liver transplantations (DDLTs) from 2005 to 2014, we retrospectively reviewed 86 (3.5%) adult patients who received a RTS graft (RTS-SLT group). The outcomes of the RTS-SLT group were compared with those of 303 recipients of whole liver (WL; WL-DDLT group). Recipient age, laboratory Model for End-Stage-Liver Disease (L-MELD) score, ischemia time, and donor-to-recipient weight ratio (DRWR) were not different between the 2 groups (P > 0.05). However, malignancy was uncommon (4.7% versus 36.3%), and the donor was younger (25.2 versus 42.7 years) in the RST-SLT group than in the WL-DDLT group (P < 0.05). The technical complication rates and the 5-year graft survival rates (89.0% versus 92.8%) were not different between the 2 groups (P > 0.05). The 5-year overall survival (OS) rate (63.1%) and graft-failure-free survival rate (63.1%) of the RTS-SLT group were worse than that of the WL-DDLT group (79.3% and 79.3%; P < 0.05). The factors affecting graft survival rates were not definite. However, the factors affecting OS in the RTS-SLT group were L-MELD score >30 and DRWR ≤1.0. In the subgroup analysis, OS was not different between the 2 groups if the DRWR was >1.0, regardless of the L-MELD score (P > 0.05). In conclusion, a sufficient volume of the graft estimated from DRWR-matching could lead to better outcomes of adult SLTs with a RTS graft, even in patients with high L-MELD scores.

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“…So far, in contrast to kidney transplantation, no allocation policy including age matching has been implemented for liver transplantation. Even though good results can be achieved by using old donors in young recipients, 127,128 it clearly appears that the impact of old donor age is more pronounced in younger recipients 129 and that redistributing young donors to young recipients might improve outcomes. 130 However, there is an imbalance between the age of the donors and the age of the recipients (Fig.…”

Section: Age Matching Between Donors and Recipients In Liver Transplamentioning

confidence: 99%

Age and liver transplantation

Durand

Levitsky

Cauchy

et al. 2019

Journal of Hepatology

201

209

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The average age of liver transplant donors and recipients has increased over the years. Independent of the cause of liver disease, older candidates have more comorbidities, higher waitlist mortality and higher post-transplant mortality than younger patients. However, transplant benefit may be similar in older and younger recipients, provided older recipients are carefully selected. The cohort of elderly patients transplanted decades ago is also increasingly raising issues concerning long-term exposure to immunosuppression and aging of the transplanted liver. Excellent results can be achieved with elderly donors and there is virtually no upper age limit for donors after brain death liver transplantation. The issue is how to optimise selection, procurement and matching to ensure good results with elderly donors. The impact of old donor age is more pronounced in younger recipients and patients with a high model for end-stage liver disease score. Age matching between the donor and the recipient should be incorporated into allocation policies with a multistep approach. However, age matching may vary depending on the objectives of different allocation policies. In addition, age matching must be revisited in the era of direct-acting antivirals. More restrictive limits have been adopted in donation after circulatory death. Perfusion machines which are currently under investigation may help expand these limits. In living donor liver transplantation, donor age limit is essentially guided by morbidity related to procurement. In this review we summarise changing trends in recipient and donor age. We discuss the implications of older age donors and recipients. We also consider different options for age matching in liver transplantation that could improve outcomes.

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Does Matching Donor-Recipient Age Affect Long-Term Survival in Liver Transplantation?

Cited by 6 publications

References 0 publications

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

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

Survival Outcomes in Split Compared With Whole Liver Transplantation

Age and liver transplantation

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