Extended-Donor Criteria Liver Allografts

Alkofer, Barbara; Samstein, Benjamin; Guarrera, James V.; Kin, Cindy; Jan, Dominique; Bellemare, Sarah; Kinkhabwala, Milan; Brown, Robert S.; Emond, Jean C.; Renz, John F.

doi:10.1055/s-2006-947292

Cited by 90 publications

(74 citation statements)

References 132 publications

(168 reference statements)

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“…Similar to prior observations, use of older donors has been independently associated with poor 5-year graft survival outcomes attributed to age-related graft qualities including fibrosis, steatosis, atherosclerosis, and increased susceptibility to ischemia-reperfusion injury, inflammation, thrombosis and T-cell mediated rejection [38–40]. In the current study, the donor age ≥60 years was also independently associated with increased 5-year mortality after adjusting for other variables.…”

Section: Discussionsupporting

confidence: 86%

Outcomes Among Older Adult Liver Transplantation Recipients in the Model of End Stage Liver Disease (MELD) Era

et al. 2014

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Background Since 2002, the Model of End Stage Liver Disease (MELD) score has been the basis of the liver transplant (LT) allocation system. Among older adult LT recipients, short-term outcomes in the MELD era were comparable to the pre-MELD era, but long-term outcomes remain unclear. Material/Methods This is a retrospective cohort study using the UNOS data on patients age ≥50 years who underwent primary LT from February 27, 2002 until October 31, 2011. Results A total of 35,686 recipients met inclusion criteria. The cohort was divided into 5-year interval age groups. Five-year over-all survival rates for ages 50–54, 55–59, 60–64, 65–69, and 70+ were 72.2%, 71.6%, 69.5%, 65.0%, and 57.5%, respectively. Five-year graft survival rates after adjusting for death as competing risk for ages 50–54, 55–59,60–64, 65–69 and 70+ were 85.8%, 87.3%, 89.6%, 89.1% and 88.9%, respectively. By Cox proportional hazard modeling, age ≥60, increasing MELD, donor age ≥60, hepatitis C, hepatocellular carcinoma (HCC), dialysis and impaired pre-transplant functional status (FS) were associated with increased 5-year mortality. Using Fine and Gray sub-proportional hazard modeling adjusted for death as competing risk, 5-year graft failure was associated with donor age ≥60, increasing MELD, hepatitis C, HCC, and impaired pre-transplant FS. Conclusions Among older LT recipients in the MELD era, long-term graft survival after adjusting for death as competing risk was improved with increasing age, while over-all survival was worse. Donor age, hepatitis C, and pre-transplant FS represent potentially modifiable risk factors that could influence long-term graft and patient survival.

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Section: Discussionsupporting

confidence: 86%

Outcomes Among Older Adult Liver Transplantation Recipients in the Model of End Stage Liver Disease (MELD) Era

et al. 2014

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“…M arginal liver grafts, rarely used in the past, have been reevaluated and introduced into clinical use to address the absolute donor shortage (1). Some marginal donor factors including gender (2), steatosis (3), and subclinical viral hepatitis (4) have been identified (5)(6)(7)(8)(9)(10).…”

mentioning

confidence: 99%

The Impact of Donor Age on the Outcome of Adult Living Donor Liver Transplantation

et al. 2008

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“…Macrovesicular steatosis (>30%) increases susceptibility to preservation-reperfusion injury, impairs regeneration, and is associated with decreased graft survival [5][6][7]. Microvesicular steatosisis often occurs after a short period of warm ischemia and usually does not adversely affect outcome.…”

Section: Deceased Donor Biopsy Evaluationmentioning

confidence: 99%