Optimizing the Use of Geriatric Livers for Transplantation in the Eurotransplant Region

Abstract

Acceptance criteria for liver allografts are ever more expanding because of a persisting wait‐list mortality. Older livers are therefore offered and used more frequently for transplantation. This study aims to analyze the use and longterm outcome of these transplantations. Data were included on 17,811 first liver transplantations (LTs) and information on livers that were reported for allocation but not transplanted from 2000 to 2015 in the Eurotransplant (ET) region. Graft survival was defined as the period between transplantation and date of retransplantation or date of recipient death. In the study period, 2394 (13%) transplantations were performed with livers ≥70 years old. Graft survival was 74%, 57%, and 41% at 1‐, 5‐, and 10‐year follow‐up, respectively. A history of diabetes mellitus in the donor (hazard ratio [HR], 1.3; P = 0.01) and positive hepatitis C virus antibody in the recipient (HR, 1.5; P < 0.001) are specific risk factors for transplantations with livers ≥70 years old. Although donor age is associated with a linearly increasing risk of graft loss between 25 and 80 years old, no difference in graft survival could be observed when “preferred” recipients were transplanted with a liver <70 or ≥70 years old (HR 1.1; CI 0.92‐1.23, P = 0.40) or with a donor <40 or ≥70 years old (HR 1.2; CI 0.96‐1.37, P = 0.13). Utilization of reported livers ≥70 years old increased from 42% in 2000‐2003 to 76% in 2013‐2015 without a decrease in graft survival ( P = 0.45). In conclusion, an important proportion of LTs in the ET region are performed with livers ≥70 years old. The risk of donor age on graft loss increases linearly between 25 and 80 years old. Livers ≥70 years old can, however, be transplanted safely in preferred patients and are to be used more frequently to further reduce wait‐list mortality.

Liver Grafts with Major Extended Donor Criteria May Expand the Organ Pool for Patients with Hepatocellular Carcinoma

“…The liver parenchyma is more vulnerable to ischemia-reperfusion injury and inflammatory cytokine responses before and after transplantation [29,30]. The risk of graft loss increases linearly from a donor age of 25 up to 80 years old, but substantial survival benefits have also been reported [21,31]. Our results and retransplant rates are in line with these reports.…”

“…The results of the present study show that patients with liver cirrhosis and HCC who generally are in a better condition may be able to overcome the negative impact of maEDC and could be transplanted with maEDC grafts without impairing patient survival. The survival rates in the study are comparable with those of other European and Asian centers, but are lower than the rates reported in the USA, which can be explained by the lower quality of liver grafts available for transplantation in Eurotransplant [16,17,20,21,22,23].…”

Predictive Capacity of Risk Models in Liver Transplantation

“…34-36 European transplant centers tend to accept livers that have a higher mean donor age and have more comorbidities on average. 37,38…”

Age Matching of Elderly Liver Grafts With Elderly Recipients Does Not Have a Synergistic Effect on Long-term Outcomes When Both Are Carefully Selected

“…5 Such findings were recently confirmed in a Eurotransplant registry analysis. 42 However, our results also highlight that older “low-risk” recipients have a considerable increased risk of death independent of age matching, stressing the emergent need to improve the preoperative risk stratification of these patients.…”