Influence of donor age on graft survival after liver transplantation-united network for organ sharing registry

Abstract

The waiting list for liver transplantation has more than doubled between 1988 and 1992, yet the number of liver transplantations during the same period increased by only 79%. This discrepancy is due to the limited availability of donors. The modest increase in donor pool is caused entirely by donors 240 years of age, a trend likely to continue. To determine the impact of increasing donor age on the outcome of liver transplantation, we analyzed 6-month graft survival in 7,988 adults who received first liver graft between October 1987 and September 1992, and were observed through the United Network for Organ Sharing Scientific Liver Transplant Registry. Graft survival was measured by death and/or retransplantation, donor age by decades. The independent effect of donor age on graft survival was estimated by Cox regression analysis controlling for the possible confounding of donor, recipient, and institutional characteristics. Between 1987 and 1992, the perhe clinical success of liver transplantation has T been accompanied by an increased demand for organs. The availability of donors relative to this demand is becoming more and more limited. With an 8% to 9% waiting list mortality in years 1988 through 1992, and an increasing median waiting time from 1 to 3 months during the same period,' the risks known or presumed to be associated with the use of "marginal" donors often may be preferred over the prospect of an unpredictably long wait for a "suitable" organ. Attempts to expand the donor pool through the relaxation of donor age criteria have been characterized by added efforts on the part of transplantation teams to verify the quality of older grafts,l and the early experience from these transplantations suggests that, in the absence of other risk parameters, organs from older donors can provide a valuable relief to the current organ shortage. Even though according to some studies3 early liver function appears to be affected by donor age, some transplantation teams have reported no difference in survival rates for liver transplantations using older donor^.^-^ However, there is not an absolute consensus on the clinical equivalence between livers from old and centage of donors over 50 years increased from 2.1% to 17.5% resulting in change of median donor age from 23 to 31 years. For donor age 250, graft failure rate was 50% higher than with donor age less than 20 years (excess for mortality was 25% and for retransplantation 94%). Adjustment for characteristics associated to donor age or outcome did not eliminate the excess risk found with increasing donor age. Despite these adversities, graft failure rate in recipients from oldest donors (27.2%) in 1992 was nearly equivalent to recipients from the youngest donors (26.9%) in 1987 to 1988. Although increasing donor age has an adverse effect on 6-month graft survival, improvement in transplantation technology and patient care over time have more than compensated for poorer graft function associated with the simultaneous rise in median donor age.Copyright o 7995 by the A...

A Revised Consideration on the Use of Very Aged Donors for Liver Transplantation

“…These latter reports reflected the current opinions and expertise available during the study periods (early 1990s) and included only a limited proportion of truly older donors (10,11).…”

MELD score predicts 1-year patient survival post-orthotopic liver transplantation

“…Selective marginal grafts, such as hepatitis C-positive grafts, hepatitis B corepositive grafts, grafts with steatosis, and older grafts have been used with acceptable results. [2][3][4][5] Living related liver graft donation and split-liver grafts also have contributed to a greater donor pool. 6,7 Another strategy has been to improve the allocation of existing grafts.…”

Liver transplantation using organs from donors older than 60 years

“…Surgical technique Outcome . Patient survival the donors' older age on the outcome of the recipients' LTx [7,8,9,10, 11,12, 131. In studies published in the early 1990s, donors older than 50 years were considered old [2,3,7,10, 121.…”