Live Donor Liver Transplantation With Older (≥50 Years) Versus Younger (&lt;50 Years) Donors

Goldaracena, Nicolás; Spetzler, Vinzent N.; Echeverri, Juan; Kaths, Moritz; Cattral, Mark S.; Greig, Paul D.; Lilly, Les; McGilvray, Ian; Levy, Gary; Ghanekar, Anand; Renner, Eberhard L.; Grant, David; Selzner, Markus; Selzner, Nazia

doi:10.1097/sla.0000000000001337

Cited by 35 publications

(72 citation statements)

References 19 publications

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“…In the same context, Goldaracena et al reported that right lobe ALDLT continues to be safe for donors and recipients when the living donor age is expanded to older than 50 years, with no difference in the 1‐year survival rate. However, they observed an earlier decline in bilirubin and international normalized ratio levels by POD 7 in the younger donor group …”

Section: Discussionmentioning

confidence: 86%

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: Discussionmentioning

confidence: 86%

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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“…At first, potential donors have to complete a screening health questionnaire as well as various blood tests, viral serology, imaging, and consultations with health care professionals from medicine and psychiatry who are independent of the transplant program. Furthermore, to evaluate graft and donor remnant liver volumes and the vascular anatomy, all potential donors undergo triphasic computed tomography as well as magnetic resonance cholangiography (MRCP) for an evaluation of the biliary anatomy . The aim is to achieve a GRWR of 0.8% or more and a residual liver volume in the donor of 30% or more.…”

Section: Methodsmentioning

confidence: 99%

Living Donor Liver Transplantation Using Selected Grafts With 2 Bile Ducts Compared With 1 Bile Duct Does Not Impact Patient Outcome

Kollmann¹,

Goldaracena²,

Sapisochín³

et al. 2018

Liver Transpl

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The outcome after living donor liver transplantation (LDLT) using grafts with multiple bile ducts (BDs) remains unclear. We analyzed 510 patients who received an adult‐to‐adult right lobe LDLT between 2000 and 2015 and compared outcome parameters of those receiving grafts with 2 BDs (n = 169) with patients receiving grafts with 1 BD (n = 320). Additionally, patients receiving a graft with 3 BDs (n = 21) were analyzed. Demographic variables and disease severity were similar between the groups. Roux‐en‐Y reconstruction was significantly more common in the 2 BD group (77% versus 38%; P < 0.001) compared with the 1 BD group. No difference was found in biliary complication rates within 1 year after LDLT (1 BD versus 2 BD groups, 18% versus 21%, respectively; P = 0.46). In the 2 BD group, 82/169 (48.5%) patients were reconstructed with 2 anastomoses. The number of anastomoses did not negatively impact biliary complication rates. Recipients’ major complication rate (Clavien ≥ 3b) was similar between both groups (1 BD versus 2 BD groups, 21% versus 24%, respectively; P = 0.36). Furthermore, no difference could be found between the 1 BD, the 2 BD, and the 3 BD groups in the frequency of developing biliary complications within 1 year (18%, 21%, 14%, respectively; P = 0.64), BD strictures (15%, 15%, 5%, respectively; P = 0.42), or BD leaks (10%, 11%, 10%, respectively; P = 0.98). In addition, the 1‐year (90% versus 91%), 5‐year (82% versus 77%), and 10‐year (70% versus 66%) graft survival rates as well as the 1‐year (92% versus 93%), 5‐year (84% versus 80%), and 10‐year (75% versus 76%) patient survival rates were comparable between the 1 BD and the 2 BD groups (P = 0.41 and P = 0.54, respectively). In conclusion, this study demonstrates that selected living donor grafts with 2 BDs can be used safely without negatively impacting biliary complication rates and graft or patient survival rates.

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“…Living donors older than 45 years are often discarded since the risks of these LDLT remains controversial. Goldaracena et al . compared patients receiving a LDLT from 91 donors aged ≥50 years with 378 younger than 50 years.…”

Section: Strategies To Overcome Donor Shortagementioning

confidence: 99%

Current challenges and future directions for liver transplantation

Toniutto

Zanetto

Ferrarese

et al. 2016

Liver International

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Liver transplantation is an effective and widely used therapy for several patients with acute and chronic liver diseases. The discrepancy between the number of patients on the waiting list and available donors remains the key issue and is responsible for the high rate of waiting list mortality. The recent news is that the majority of patients with hepatitis C virus related liver disease will be cured by new antivirals therefore we should expect soon a reduction in the need of liver transplantation for these recipi-

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Live Donor Liver Transplantation With Older (≥50 Years) Versus Younger (<50 Years) Donors

Abstract: Right lobe LDLT with donors aged 50 years or older results in acceptable recipient outcome without increased donor morbidity or mortality. Potential live donors should not be declined on the basis of age alone.

Cited by 35 publications

References 19 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

Living Donor Liver Transplantation Using Selected Grafts With 2 Bile Ducts Compared With 1 Bile Duct Does Not Impact Patient Outcome

Current challenges and future directions for liver transplantation

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