Liver transplantation using organs from donors older than 60 years

Abstract

At present, it is frequently accepted to expand the organ pool for liver transplantation (LTx) by including livers from critical donors. From 1990 to June 2002 a total of 1,208 LTx were performed. Of those, 67 livers from donors older than 60 years were transplanted to 66 patients, including re-LTx in eight patients. Fourteen patients had malignant diseases (21 YO). Ten patients had a high urgency status (15%). Median donor age was 65 years (range 61-80 years). Primary graft function was observed in 84%. Patient survival rate at 1 and 5 years was 79% and 62%, and graft survival was 68% and 53%, respecDespite great efforts, the shortage of organ donors has not been solved in many European countries. In fact, the number of critical organ donors, such as donors older than 60 years of age, has increased constantly. To overcome the high mortality of patients with end-stage liver disease on the waiting list, certain transplant centres have recently accepted liver grafts from these critical donors.Thomas E. Starzl and his co-workers were the first to describe that livers from older donors ( > 5 0 years) could be used successfully for liver transplantation (LTx) [I]. Since then, numerous studies have shown that livers from older donors can be transplanted as successfully as livers from younger donors [2, 3, 4, 5, 61, while others have presented a significant influence of tively. No difference was observed in LTx with livers from donors younger than 60 years. Fifteen graft losses occurred during the study. Surgical complications were observed in 23 patients (34%). The outcome of LTx with livers from donors older than 60 years is satisfactory and is comparable to results of LTx with livers from donors younger than 60 years. The frequency of vascular complications and cholestasis syndrome is not increased. Keywords Liver transplantationDonor age . 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. More recent reports presented results of LTx with livers from donors older than 60 years [8,9, 111 or even older than 70 years [4,6, 131. However, the number of patients enrolled in most singlecentre studies was very low, rarely exceeding 30 patients who underwent LTx [2, 3, 7, 8, 11, 131. In this study we have retrospectively analysed 67 patients who underwent LTx with livers from donors older than 60 years in the last decade with a mean follow-up time of 29.8 months (range 4.1-129.6 months). We studied early and late graft function of liver grafts from donors older than 60 years. The incidence of vascular and bile-duct complications were of particular interest. 417 Patients and methods RecipientsFrom 1 January 1990 to 30 June 2002 a total of 1,208 liver transplant surgeries were performed at our centre, including first LTx in 1,018 patients, second LTx in 173 patients, third LTx in 16 patients and fourth LTx in one patient. The inclus...

Elderly donor liver grafts are not associated with a higher incidence of biliary complications after liver transplantation: results of a national multicenter study

“…Several donor risk analyses of US and European transplant registries have reported that advanced age is an independent predictor for worse postoperative outcome after LT . Single‐center studies, however, reported that elderly donor livers can be used for LT with favorable patient/graft survival rates . The results of the current study are consistent with these single‐center reports.…”

“…Furthermore, in our study, several confounding factors were excluded due to the fact that recipients of an elderly donor liver and their control recipients were matched for MELD score, type of donation (DBD/DCD), and recipient age. Next to single‐center reports with good postoperative outcome after LT with elderly donor livers , the incidence of other major donor‐related risk factors such as DCD and split liver donation is minimal in the current series. Likewise, it should be noticed that these elderly donor liver grafts were transplanted in relatively stable patients without high MELD scores and without major risk factors for postoperative graft failure (e.g.…”

Selective Use of Older Adults in Right Lobe Living Donor Liver Transplantation

“…Abt et al found that older living donor age >44 years, female‐to‐male donor to recipient relationship, recipient race and the recipients' medical condition before RLDLT were factors related to allograft failure (16). In contrast to these studies, however, there are many other reports which have failed to corroborate a deleterious effect of increased donor age (4,33,34).…”

Liver grafts from selected older donors do not have significantly more ischaemia reperfusion injury

“…Data from the OPTN for all liver transplants performed in the USA between 1997 and 2004 showed that the survival rates for both recipients and grafts from donors aged ≥65 years are lower than those for recipients and grafts from donors aged 18–34 years at 1 year (80.6% vs. 87.7%, and 74.2% vs. 84.2%, respectively) and 5 years (66.1% vs. 76.5% and 51.6% vs. 70.4%, respectively) 38 . However, single‐centre analyses have failed to demonstrate significant differences in short‐ and medium‐term graft and patient survival using donors aged >60 years, 39–49 especially in the absence of other donor risk factors and in carefully selected recipients 46–49 . In a large cohort study, Hoofnagle and colleagues showed that the overall incidence of poor graft survival was more common among recipients of older livers, but that recipients of older liver grafts assessed as good by the procuring surgeon had a retransplant‐free survival similar to that of recipients of younger livers (87% vs. 91% at 3 months).…”