Impact of Donor Age on Recipient Survival in Adult-to-Adult Living-donor Liver Transplantation

Kubota, Takumi; Hata, Koichiro; Sozu, Takashi; Ueda, Yoshihide; Hirao, Hirofumi; Okamura, Yusuke; Tamaki, Ichiro; Yoshikawa, Junichi; Kusakabe, Jiro; Tanaka, Hirokazu; Kageyama, Shoichi; Anazawa, Takayuki; Yoshizawa, Atsushi; Yagi, Shintaro; Yamashiki, Noriyo; Okajima, Hideaki; Kaido, Toshimi; Üemoto, Shinji

doi:10.1097/sla.0000000000002194

Cited by 67 publications

(79 citation statements)

References 42 publications

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“…However, there was no difference between the 2 groups in and after April 2006 . Recently, we also reported that younger donor age, especially in the third decade of life, and the use of right lobe grafts were independent prognostic factors for improving recipient survival after ALDLT . In our study, older donor age (≥45 years) was associated with poorer outcomes of ALDLT in recipients receiving SFSGs regardless of the graft type or etiology of the original liver disease.…”

Section: Discussionsupporting

confidence: 38%

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

et al. 2019

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Adult‐to‐adult living donor liver transplantation (ALDLT) using small‐for‐size grafts (SFSGs), ie, a graft with a graft‐to‐recipient weight ratio (GRWR) <0.8%, has been a challenge that should be carefully dealt with, and risk factors in this category are unclear. Therefore, we aimed to examine the risk factors and outcomes of ALDLT using SFSGs over a 13‐year period in 121 patients who had undergone their first ALDLT using SFSGs. Small‐for‐size syndrome (SFSS), early graft loss, and 1‐year mortality were encountered in 21.6%, 14.9%, and 18.4% of patients, respectively. By multivariate analysis, older donor age (≥45 years) was an independent risk factor for SFSS (odds ratio [OR], 4.46; P = 0.004), early graft loss (OR, 4.11; P = 0.02), and 1‐year mortality (OR, 3.76; P = 0.02). Child‐Pugh C class recipients were associated with a higher risk of SFSS development (P = 0.013; OR, 7.44). Despite no significant difference between GRWR categories in the multivariate outcome analysis of the whole population, in the survival analysis of the 2 donor age groups, GRWR <0.6% was associated with significantly lower 1‐year survival than the other GRWR categories in the younger donor group. Moreover, in the high final portal venous pressure (PVP) group (>15 mm Hg), younger ABO‐compatible donors showed 100% 1‐year survival with a significant difference from the group of other donors. Older donor age was an independent risk factor for SFSS, early graft loss, and 1‐year mortality after ALDLT using SFSGs. GRWR should not be <0.6%, and PVP modulation is indicated when grafts from older or ABO‐incompatible donors are used.

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Section: Discussionsupporting

confidence: 38%

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

et al. 2019

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“…There are reports that older age of donors is associated with higher mortality of the recipients (35). More than 60% of our donors aged between 19 to 45 years.…”

Section: Discussionmentioning

confidence: 77%

Evolution of Liver Transplantation Program in Shiraz, Iran

et al. 2017

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“…Second, optimization of PVP alone cannot guarantee graft survival. Other factors, including the recipient’s condition and donor graft quality, also affect survival . However, given our findings during the last 10 years, the benefits of PVP modulation cannot be denied.…”

Section: Discussionmentioning

confidence: 81%

“…ABO incompatibility and older donor are well‐known risk factors in ALDLT . However, the associations between PHT have rarely been described.…”

Section: Discussionmentioning

confidence: 99%

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Is Portal Venous Pressure Modulation Still Indicated for All Recipients in Living Donor Liver Transplantation?

Yao¹,

Kaido²,

Uozumi

et al. 2018

Liver Transpl

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There is a consensus that portal venous pressure (PVP) modulation prevents portal hypertension (PHT) and consequent complications after adult-to-adult living donor liver transplantation (ALDLT). However, PVP-modulation strategies need to be updated based on the most recent findings. We examined our 10-year experience of PVP modulation and reevaluated whether it was necessary for all recipients or for selected recipients in ALDLT. In this retrospective study, 319 patients who underwent ALDLT from 2007 to 2016 were divided into 3 groups according to the necessity and results of PVP modulation: not indicated (n = 189), indicated and succeeded (n = 92), and indicated but failed (n = 38). Graft survival and associations with various clinical factors were investigated. PVP modulation was performed mainly by splenectomy to lower final PVP to ≤15 mm Hg. Successful PVP modulation improved prognosis to be equivalent to that of patients who did not need modulation, whereas failed modulation was associated with increased incidence of small-for-size syndrome (SFSS; P = 0.003) and early graft loss (EGL; P = 0.006). Among patients with failed modulation, donor age ≥ 45 years (hazard ratio [HR], 3.67; P = 0.02) and ABO incompatibility (HR, 3.90; P = 0.01) were independent risk factors for graft loss. Survival analysis showed that PVP > 15 mm Hg was related to poor prognosis in grafts from either ABO-incompatible or older donor age ≥ 45 years (P < 0.001), but it did not negatively affect grafts from ABO-compatible/identical and young donor age < 45 years (P = 0.27). In conclusion, intentional PVP modulation is not necessarily required in all recipients. Although grafts from both ABO-compatible/identical and young donors can tolerate PHT, lowering PVP to ≤15 mm Hg is a key to preventing SFSS and consequent EGL with grafts from either ABO-incompatible or older donors.

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Impact of Donor Age on Recipient Survival in Adult-to-Adult Living-donor Liver Transplantation

Abstract: Donor age is an independent, strong prognostic factor in adult-to-adult LDLT.

Cited by 67 publications

References 42 publications

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

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

Evolution of Liver Transplantation Program in Shiraz, Iran

Is Portal Venous Pressure Modulation Still Indicated for All Recipients in Living Donor Liver Transplantation?

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