Liver Transplant Recipient Characteristics Associated With Worse Post-Transplant Outcomes in Using Elderly Donors

Abstract

Advanced age of liver donor is a risk factor for graft loss after transplant. We sought to identify recipient characteristics associated with negative post-liver transplant (LT) outcomes in the context of elderly donors. Using 2014–2019 OPTN/UNOS data, LT recipients were classified by donor age: ≥70, 40–69, and <40 years. Recipient risk factors for one-year graft loss were identified and created a risk stratification system and validated it using 2020 OPTN/UNOS data set. At transplant, significant recipient risk factors for one-year graft loss were: previous liver transplant (adjusted hazard ratio [aHR] 4.37, 95%CI 1.98–9.65); mechanical ventilation (aHR 4.28, 95%CI 1.95–9.43); portal thrombus (aHR 1.87, 95%CI 1.26–2.77); serum sodium <125 mEq/L (aHR 2.88, 95%CI 1.34–6.20); and Karnofsky score 10–30% (aHR 2.03, 95%CI 1.13–3.65), 40–60% (aHR 1.65, 95%CI 1.08–2.51). Using those risk factors and multiplying HRs, recipients were divided into low-risk (n = 931) and high-risk (n = 294). Adjusted risk of one-year graft loss in the low-risk recipient group was similar to that of patients with younger donors; results were consistent using validation dataset. Our results show that a system of careful recipient selection can reduce the risks of graft loss associated with older donor age.

Survival after LDLT in recipients ≥70 years old in the United States. An OPTN/UNOS liver transplant registry analysis

“…Recipients in the LDLT ≥70y group had significantly lower rates of HCC diagnosis with and without cirrhosis versus the DDLT ≥70y group (Table 2). Similarly, significantly less disease burden was found in the LDLT ≥70y group when compared to recipients in the DDLT ≥70y group in terms of lower MELD score (15 (11-21) vs. 17 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)…”

“…The important role of donor age on post-transplant outcomes has been vastly studied, primarily for DDLT. 20,21 However, evidence regarding the impact of donor age in LDLT recipient outcomes is scarce and contradictory. To date, there is no current cutoff for upper donor age in LDLT, and practices vary among centers.…”

Current Understanding of Marginal Grafts in Liver Transplantation

“…Multiple studies have shown the impact of elderly liver grafts on post-transplant mortality, a phenomenon that exhibits variability in the age of recipients, particularly among younger recipients [9,26,27]. LT from donors aged 60 or older has great transplant outcomes, with no significant difference in 1-year and 5-year survival rates compared with patients receiving old and normal liver grafts [28][29][30].…”

Mitochondrial Autophagy in Ischemic Aged Livers

“…Preferred recipients who are less likely to incur additional risks associated with aged donor liver include the following: (1) first-time transplant recipients over the age of 45 years, (2) a body mass index (BMI) < 35, and (3) a cold ischemic time < 8 h [140]. Other recipient factors, such as mechanical ventilation, portal thrombus, and low serum sodium value, appear to also be important in the survival of aged grafts [141]. Interestingly, the age of recipients may not be a major risk factor [141][142][143].…”

“…Other recipient factors, such as mechanical ventilation, portal thrombus, and low serum sodium value, appear to also be important in the survival of aged grafts [141]. Interestingly, the age of recipients may not be a major risk factor [141][142][143].…”