Late liver function with graft obtained from donors above 65 years

Abstract

ALTHOUGH liver size diminishes with increasing age, neither the hepatic function nor the hepatic flow are significantly modified by this condition. The consideration of these facts, together with the aging of population and the reduced number of liver donors available, have resulted in the use of elder donors. [1][2][3][4] Although the early function of grafts from donors above 65 years of age has been proven to be as good as that obtained with grafts from young donors, 1,5 their late function is less known. MATERIALS AND METHODSThe late hepatic function of grafts obtained from donors above 65 years old was studied. We reviewed two liver transplant patient groups receiving liver transplantation between January 1997 and June 2000: (1) group A (n = 17), donors above 65 years of age; and (2) group B (n = 66), donors below 65 years. Donor acceptance criteria, surgical preservation and transplantation technique, recipient selection criteria, and postsurgery care were similar for both groups.The early hepatic function was studied through the following parameters: maximum AST and ALT values, prothrombin time activity (%) (PT), seventh-day bilirubin, length of hospital stay, graft primary nonfunction, and development of initial poor function (defined as elevation of ALT or AST above 2000 U and PT activity below 40%). The late hepatic function was characterized by hepatic function at 1-year post transplantation, late surgical complications, and recurrence of hepatic disease. Graft and patient survival curves were calculated using Kaplan-Meier estimates, and the different curves were compared using log-rank statistics. RESULTSAverage donor age was 70 ± 3.8 years for group A, and 39 ± 17.2 years for group B (P < .001). No differences were observed between both groups regarding cause of death, length of stay in the intensive care unit, hypotension, and hypernatremia. Average recipient age was 61.6 ± 7.2 years for group A and 57.1 ± 9.1 years for group B (P = .30). No differences were observed between both groups regarding waiting time on the transplant list or the cause and severity of hepatic disease according to Child-Pugh classification. Eight recipients in group A (47%) and 24 in group B (36.4%) (P = .419) had hepatocarcinoma. The time of cold ischemia was 5.11 ± 1.2 hours for group A and 5.16 ± 1.39 hours for group B (P = .546). The times of warm ischemia were 0.65 ± 0.17 hours and 0.62 ± 0.15 hours for groups A and B, respectively (P = .887). No differences were observed regarding transfusion of packed red blood cells and plasma.