Recipient age affects long-term outcome and hepatitis C recurrence in old donor livers following transplantation

Abstract

We studied the role of donor and recipient age in transplantation/ischemia-reperfusion injury (TIRI) and short-and long-term graft and patient survival. Eight hundred twenty-two patients underwent deceased donor liver transplantation, with 197 donors being Ն60 years old. We evaluated markers of reperfusion injury, graft function, and clinical outcomes as well as short-and long-term graft and patient survival. Increased donor age was associated with more severe TIRI and decreased 3-and 5-year graft survival (73% versus 85% and 72% versus 81%, P Ͻ 0.001) and patient survival (77% versus 88% and 77% versus 82%, P Ͻ 0.003). Hepatitis C virus (HCV) infection and recipient age were the only independent risk factors for graft and patient survival in patients receiving an older graft. In the HCV(ϩ) cohort (297 patients), patients Ն 50 years old who were transplanted with an older graft versus a younger graft had significantly decreased 3-and 5-year graft survival (68% versus 83% and 64% versus 83%, P Ͻ 0.009). In contrast, HCV(ϩ) patients Ͻ 50 years old had similar 3-and 5-year graft survival if transplanted with either a young graft or an old graft (81% versus 82% and 81% versus 82%, P ϭ 0.9). In conclusion, recipient age and HCV status affect the graft and patient survival of older livers. Combining older grafts with older recipients should be avoided, particularly in HCV(ϩ) patients, whereas the effects of donor age can be minimized in younger recipients. Liver Transpl 15: 1288Transpl 15: -1295Transpl 15: , 2009 Liver transplantation is the only chance of cure for patients with end-stage liver disease and results in a 5-year survival rate of 70% to 85% in most centers. Although demand for the operation has increased, rates of deceased organ donation have not kept pace, and this had led to a marked shortage of organs available for transplantation. 1 One response to this shortage has been to accept increasingly older donors. In 1988, only 28% of all donors were older than 50 years, and 0.05% were older than 65. By 1995, these percentages had increased to 42% and 5%, and by 2007, they had increased even further to 65% and 10%, respectively.

Donor Age Affects Liver Regeneration during Early Period in the Graft Liver and Late Period in the Remnant Liver after Living Donor Liver Transplantation

“…As to the risk factors affecting recipient's survival, HCV infection has been well recognized, and it was recently revealed that increased donor age is associated with more severe HCV recurrence [4,5,10]. In our study, there were no significant differences in the survival rates of HCV-positive recipients between the older and younger donor groups, probably because of the small number of cases.…”

Hepatectomy in Elderly Patients: Does Age Matter?

“…Data from clinical studies suggest that the use of older liver grafts is associated with decreased long-term graft and patient survival [38,39]. Hence, whether elderly populations can undergo successful hepatectomy without serious outcomes has become a subject of concern.…”

Prevention of hepatitis C recurrence after liver transplantation: An update

“…In 2005, the analysis of the US Scientific Registry of Transplant Recipients, including 3463 patients with hepatitis C, evidenced that donor age between 41 years and 50 years was associated with a 67% increase in the risk of graft loss; the risk increased to 86% for donors between 51 years and 60 years of age and was more than 2-fold greater when donors were older than 60 years [57] . Interestingly, Selzner et al [58] showed that younger HCV positive patients with older grafts had better long-term results when compared with older HCV positive recipients receiving older grafts. Ideally, HCV-infected transplant recipients should not receive organs from older donors; however, considering the vast number of HCVinfected patients awaiting LT, this may not be feasible for many programs.…”