Nonagenarian Grafts for Liver Transplantation

Ghinolfi, Davide; Pezzati, Daniele; Rreka, Erion; Balzano, E; Catalano, G; Coletti, L; Tincani, Giovanni; Carrai, P; Petruccelli, S; Martinelli, Cristina; Aglietti, Rebecca; Bindi, Massimo; Morganti, Riccardo; Biancofiore, Gianni; Simone, Paolo De

doi:10.1002/lt.25580

Cited by 17 publications

(18 citation statements)

References 4 publications

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“…3 A recent series of nonagenarian livers reported three cases (19%) of biliary anastomotic stricture successfully treated by endoscopic dilation, and a 100% 1-year patient and graft survival rate. 34 In the present series, we found one case (16.6%) of BC in the nonagenarian group versus five cases (10.2%) in the octogenar-ian group. Initially, the five cases of ABS were successfully treated with percutaneous dilation, but in three cases was necessary to perform an HJ (one in the case group and one in the control group), and the case of BL was successfully treated with percutaneous drainage.…”

Section: Discussionsupporting

confidence: 41%

Expanding donor age in liver transplantation using liver grafts from nonagenarian donors

Jiménez-Romero

Alonso

Marcacuzco

et al. 2022

Clinical Transplantation

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Introduction: Satisfactory outcomes in a series of liver transplantations (LT) with octogenarian liver grafts have been reported, as well as several cases of LT using nonagenarian liver grafts with short follow-up. Methods:From October 2013 to December 2019, we performed 426 LT. Six LTs used nonagenarian livers (case group) and 49 used octogenarian livers (control group). A comparative analysis was performed between groups. Median donor age was significantly higher in the nonagenarian group than in the octogenarian group (90.6 years versus 83.4 years; (P < .001). There was a significant difference in LT indications (P = .026) between the groups, but not in perioperative recipient variables, morbidity, or mortality. The 1-, 3-, and 5-year patient survival rates were 67.7% in the recipients of nonagenarian livers and 85.7%, 78.0%, and 74.4%, respectively, in the recipients of octogenarian livers (P = .631). The 1-, 3-, and 5-year graft survival rates were 66.7% in the recipients of nonagenarian livers and 81.3%, 73.8%, and 70.3%, respectively, in the recipients of octogenarian livers (P = .745). Conclusions:The results of LT with nonagenarian liver grafts are not significantly different from those obtained with octogenarian donors, taking into consideration the small sample size and careful selection of donors and adequate donor-recipient matching.

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Section: Discussionsupporting

confidence: 41%

Expanding donor age in liver transplantation using liver grafts from nonagenarian donors

Jiménez-Romero

Alonso

Marcacuzco

et al. 2022

Clinical Transplantation

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“…91,92 Randomized controlled trials in Europe are ongoing to confirm findings from small series of benefit with NMP in extended criteria donors. 86,93,94 Finally, there are several discrepancies in nomenclature and variable reporting in the literature (such as temperature, perfusion [single/dual (arterial and portal) timing (before the organ is placed on ice for transport (prestatic cold storage)], before organ implantation (poststatic cold storage), and for the entire preservation period between procurement and implantation [preservation]), which makes data interpretation challenging, potentially slowing the progress in this field. 79…”

Section: Challengesmentioning

confidence: 99%

“…81 Following the first clinical report on the safety and feasibility of NMP, several groups have demonstrated promising results with NMP. [82][83][84][85][86][87] A phase 3 randomized trial of 220 LT patients, 80 comparing static cold storage (SCS) to NMP, demonstrated a 50% decrease in graft injury (measured by peak aspartate aminotransferase), 88 a 50% lower organ discard rate (11.7% NMP versus 24.1% SCS; P = 0.008), lower rate of postreperfusion syndrome (12.4% NMP versus 40% SCS; P < 0.001), and 54% longer preservation time. This study did not identify differences in biliary stricture rate, graft, or patient survival.…”

Section: Challengesmentioning

confidence: 99%

Changing Trends in Liver Transplantation: Challenges and Solutions

Ivanics¹,

Abreu²,

Martin³

2020

Transplantation

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Despite improvements in postliver transplant outcomes through refinements in perioperative management and surgical techniques, several changing trends in liver transplantation have presented challenges. Mortality on the waitlist remains high. In the United States, Europe, and the United Kingdom, there is an increasing need for liver transplantation, primarily as a result of increased incidence of nonalcoholic steatohepatitis-related cirrhosis and cancer indications. Meanwhile, donor suitability has decreased, as donors are often older and have more comorbidities. Despite a mismatch between organ need and availability, many organs are discarded. Notwithstanding this, many solutions have been developed to overcome these challenges. Innovative techniques in allograft preservation, viability assessment, and reconditioning have allowed the use of suboptimal organs with adequate results. Refinements in surgical procedures, including live donor liver transplantations, have increased the organ pool and are decreasing the time and mortality on the waitlist. Despite many challenges, a similar number of solutions and prospects are on the horizon. This review seeks to explore the changing trends and challenges in liver transplantation and highlight possible solutions and future directions.

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“…The ongoing discrepancy between organ demand and supply has moved the spotlight toward implementing rescue strategies for extending the pool to deceased donors that were previously considered marginal or even unsuitable for transplantation [ 1 , 2 , 3 ]. In the last years, ex-situ machine perfusion (MP) emerged as an alternative to static cold storage (SCS) preservation, especially in extended criteria donors (ECD), which have a higher susceptibility to ischemia reperfusion injury (IRI) compared to standard donors [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Viability Criteria during Liver Ex-Situ Normothermic and Hypothermic Perfusion

et al. 2022

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With the increased use of extended-criteria donors, machine perfusion became a beneficial alternative to cold storage in preservation strategy for donor livers with the intent to expand donor pool. Both normothermic and hypothermic approach achieved good results in terms of mid- and long-term outcome in liver transplantation. Many markers and molecules have been proposed for the assessment of liver, but no definitive criteria for graft viability have been validated in large clinical trials and key parameters during perfusion still require optimization.In this review, we address the current literature of viability criteria during normothermic and hypothermic machine perfusion and discuss about future steps and evolution of these technologies.

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Nonagenarian Grafts for Liver Transplantation

Cited by 17 publications

References 4 publications

Expanding donor age in liver transplantation using liver grafts from nonagenarian donors

Expanding donor age in liver transplantation using liver grafts from nonagenarian donors

Changing Trends in Liver Transplantation: Challenges and Solutions

Viability Criteria during Liver Ex-Situ Normothermic and Hypothermic Perfusion

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