Octogenarian Donors in Liver Transplantation

Gastaca, Mikel; Guerra, Mikel; Martínez, L Álvarez; Ruíz, P.; Ventoso, A.; Palomares, I.; Prieto, Mikel; Matarranz, A.; Valdivieso, A.; Urbina, J. Ortiz de

doi:10.1016/j.transproceed.2016.06.063

Cited by 13 publications

(18 citation statements)

References 7 publications

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“…Despite some age-related changes in morphology and function, liver appears to preserve its functionality at older ages much better than other tissues 1 , with important implications in translations research, including the selection of donors in liver transplants. Indeed, available data suggest that transplants from older donors have duration and success rates comparable to those from young donors 2,3 .…”

Section: Introductionmentioning

confidence: 99%

Molecular Aging of Human Liver: An Epigenetic/Transcriptomic Signature

Bacalini

Franceschi

Gentilini

et al. 2018

The Journals of Gerontology: Series A

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The feasibility of liver transplantation from old healthy donors suggests that this organ is able to preserve its functionality during aging. To explore the biological basis of this phenomenon, we characterized the epigenetic profile of liver biopsies collected from 45 healthy liver donors ranging from 13 to 90 years old using the Infinium HumanMethylation450 BeadChip. The analysis indicates that a large remodeling in DNA methylation patterns occurs, with 8823 age-associated differentially methylated CpG probes. Notably, these age-associated changes tended to level off after the age of 60, as confirmed by Horvath's clock. Using stringent selection criteria we further identified a DNA methylation signature of aging liver including 75 genomic regions. We demonstrated that this signature is specific for liver compared to other tissues and that it is able to detect biological age-acceleration effects associated with obesity. Finally we combined DNA methylation measurements with available expression data. Although the intersection between the two omic characterizations was low, both approaches suggested a previously unappreciated role of epithelial-mesenchymal transition and Wnt signaling pathways in the aging of human liver.

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Section: Introductionmentioning

confidence: 99%

Molecular Aging of Human Liver: An Epigenetic/Transcriptomic Signature

Bacalini

Franceschi

Gentilini

et al. 2018

The Journals of Gerontology: Series A

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“…Many studies show that using liver grafts from septuagenarian donors is not a contraindication to their utilization in DDLT per se [14]; however, some studies report significantly worse patient and graft survival when using liver grafts from donors older than 70 years [16][17][18]. Since the first reported case of successful graft from an 86-yearold donor [19], others have reported using liver grafts from octogenarian donors [2,14,20,21]; other studies have used grafts from nonagenarian donors [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…Use of marginal donors, particularly older donors, is an important approach to expanding the donor pool [ 1 , 2 ]. Although favorable LT outcomes have been achieved with elderly donors [ 1 - 4 ], there is still a certain reluctance to use them due to concerns about early graft function and long-term graft survival.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of deceased donor liver transplantation from elderly donors

Kim

Hwang

Ahn

et al. 2021

Korean Journal of Transplantation

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Background: Favorable outcomes achieved after deceased donor liver transplantation (DDLT) suggest that use of elderly donors may be an effective way to expand donor pool. Methods: This was a retrospective analysis of adult DDLT using elderly donors. It was a double-arm study that compared posttransplant outcomes to ascertain whether use of elderly donors (aged ≥76 years) has adverse effects on outcome of DDLT. Elderly donor study group included 14 donors aged ≥76 years and elderly donor control group comprised 39 donors aged 66-75 years. Results: Mean donor age of the study and control groups was 78.2±3.1 years and 68.9±2.7 years, respectively (P<0.001). Other clinical parameters were comparable between these two donor groups. The 1-, 3-, and 5-year graft survival rates in the elderly study group were 83.6%, 59.7%, and 59.7%, respectively, and those in the elderly control group were 79.4%, 68.1%, and 59.6%, respectively (P=0.97). The overall 1-, 3-, and 5-year survival rates after donation from elderly study group were 83.6%, 59.7%, and 59.7%, respectively, and those after donation from control group were 79.3%, 72.1%, and 64.1%, respectively (P=0.74). Regarding overall patient survival, univariate analysis identified pretransplant requirement for ventilator support (P=0.021) and pretransplant renal replacement therapy (P=0.025) as statistically significant risk factors; however, neither was significant on multivariate analysis. Conclusions:The results of this study suggest that using an elderly donor graft might not worsen the posttransplant outcomes significantly; thus, advanced age per se may not be an exclusion criterion for organ donation.

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“…It is unlikely a difference will be noted between two recipients of a donor only slightly above or below the investigated age cut-off (ie, a recipient of an 80-year-old allograft may be compared to the recipient of a 78-year-old allograft). [23][24][25][26][27][28] In addition without accounting for recipient characteristics, any comparison can be challenging. Comparing outcomes for a recipient with HCV or HCC to others may make any effect of the donor age irrelevant.…”

Section: Discussionmentioning

confidence: 99%

“…This is in contrast to the earliest published studies that showed poor initial function and worse overall graft and patient survival, 6,19,[28][29][30][31] but confirms the positive results of more recent studies. [23][24][25][26][27][28] This, however, should be taken in context, as although not statistically significant, the difference (2× increased of mortality) in survival may be clinically relevant, as the study is underpowered. A larger study using similarly matched controls would better answer this question.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of the octogenarian donor liver recipient: The era of the new centurion

Schneider

Jaime

Mara

et al. 2019

Clinical Transplantation

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Over the last decade, the limited number of deceased donors has resulted in longer waiting times and increased mortality on the waitlist. 1,2 In order to tackle this growing demand and organ shortage, several efforts have been pursued to widen the donor pool. Grafts from living donation, split-liver grafts, donation after circulatory death (DCD), and extended criteria donors (ECDs) including elderly donors are increasingly being used. [3][4][5] The relationship between donor age and LT outcomes has been widely studied, with controversial results. Initial studies reported older donor age as one of the most important negative prognostic factors for patient and graft survival. 6 More recent data, however, confirmed the safety with good short-and medium-term outcomes of these grafts, when recipients were appropriately selected. 1,7 A Abstract Background: Studies have suggested transplantation using older donor livers results in similar short-term outcomes as younger donor livers; however, little data exist on long-term patient/graft outcomes of the octogenarian liver recipient. Methods: Retrospective data were collected from 2 centers, (Valencia, Spain and Rochester, MN, USA) of all recipients of octogenarian donor liver allografts from 2000 to 2011 with follow-up to 2016. The aim was to compare long-term patient/ graft survival as well as metabolic outcomes of the recipient with the octogenarian liver vs younger than 60 years donor.Results: 78 recipients of older liver allografts were compared to 78 matched controls. No difference in 10-year patient mortality was demonstrated (P = 0.074).Octogenarian livers were associated with 3-fold higher likelihood of graft failure (P = 0.002) but no increase in the risk of post-LT cardiovascular disease (P = 0.60), hypertension (P = 0.33), vascular complications (P = 0.53), or malignancy (P = 0.14).In multivariate analysis, elder livers remained a significant factor associated with rejection (P = 0.034) with a trend not reaching statistical significance for graft failure (P = 0.052).Conclusions: For appropriately selected recipients, receiving an octogenarian liver does not clearly influence patient survival but does impact early graft survival with a notable increase in early posttransplant rejection rates and re-transplantation. Over 1.5 decades, older allografts have not adversely affected metabolic outcomes. K E Y W O R D S cardiovascular, donor age, elder, liver transplantation, metabolic, survival 2 of 9 | SCHNEIDER Et al. report from the Scientific Registry of Transplant Recipient (SRTR) data once again questioned the utilization of the older donors,showing increased graft and patient mortality. 8,9 Many factors contribute to patient and graft outcomes, and most of these studies cannot separate outcomes specifically related to the donor organ received.The liver has a significant role in metabolic functions. In liver transplant recipients, the graft becomes the main organ for carbohydrate, protein, lipid, and drug metabolism, responsible for the maintenance of glucose hom...

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Octogenarian Donors in Liver Transplantation

Cited by 13 publications

References 7 publications

Molecular Aging of Human Liver: An Epigenetic/Transcriptomic Signature

Molecular Aging of Human Liver: An Epigenetic/Transcriptomic Signature

Outcomes of deceased donor liver transplantation from elderly donors

Long‐term outcomes of the octogenarian donor liver recipient: The era of the new centurion

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