Recipient Age and Mortality After Liver Transplantation: A Population-based Cohort Study

Gil, Eunmi; Kim, Jong Man; Jeon, Kyeongman; Park, Hye Jeong; Kang, Danbee; Cho, Juhee; Suh, Gee Young; Park, Jinkyeong

doi:10.1097/tp.0000000000002246

Cited by 70 publications

(60 citation statements)

References 34 publications

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“…Because it was ensured that the postperfusion PP was <18 mm Hg in all low-GRWR grafts, it is not surprising that the PP was not found to be a significant factor in their outcome. Others have also found MELD, (45,46) age, (47) and PP (5) to be important in this situation. Unlike in some other studies, (14,38) PF was not an important determinant of outcome of low-GRWR grafts in our study.…”

Section: Discussionmentioning

confidence: 89%

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

et al. 2019

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Although the well‐accepted lower limit of the graft‐to‐recipient weight ratio (GRWR) for successful living donor liver transplantation (LDLT) remains 0.80%, many believe grafts with lower GRWR may suffice with portal inflow modulation (PIM), resulting in equally good recipient outcomes. This study was done to evaluate the outcomes of LDLT with small‐for‐size grafts (GRWR <0.80%). Of 1321 consecutive adult LDLTs from January 2012 to December 2017, 287 (21.7%) had GRWR <0.80%. PIM was performed (hemiportocaval shunt [HPCS], n = 109; splenic artery ligation [SAL], n = 14) in 42.9% patients. No PIM was done if portal pressure (PP) in the dissection phase was <16 mm Hg. Mean age of the cohort was 49.3 ± 9.1 years. Median Model for End‐Stage Liver Disease score was 14, and the lowest GRWR was 0.54%. A total of 72 recipients had a GRWR <0.70%, of whom 58 underwent HPCS (1 of whom underwent HPCS + SAL) and 14 underwent no PIM, whereas 215 had GRWR between 0.70% and 0.79%, of whom 51 and 14 underwent HPCS and SAL, respectively. During the same period, 1034 had GRWR ≥0.80% and did not undergo PIM. Small‐for‐size syndrome developed in 2.8% patients. Three patients needed shunt closure at 1 and 4 weeks and 60 months. The 1‐year patient survival rates were comparable. In conclusion, with PIM protocol that optimizes postperfusion PP, low‐GRWR grafts can be used for appropriately selected LDLT recipients with acceptable outcomes.

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Section: Discussionmentioning

confidence: 89%

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

et al. 2019

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“…We already reported using the data from the Korean National Health Insurance System that recipient age is an important factor for in-hospital mortality after DDLT. 16 A single-center study showed that patients aged ≥70 years should not be excluded from LT or even LDLT based solely on recipient age. This implies that careful selection of recipients and donors and meticulous surgical technique are necessary for successful results.…”

Section: Discussionmentioning

confidence: 99%

<p>Generic Tacrolimus (Tacrobell<sup>®</sup>) Shows Comparable Outcomes to Brand-Name Tacrolimus in the Long-Term Period After Adult Deceased Donor Liver Transplantation</p>

Kim

Choi

Lee

2019

DDDT

Self Cite

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Background: Generic tacrolimus (Tacrobell ® ) is commonly used in liver transplant patients in Korea. No previous studies have assessed the long-term efficacy and safety of generic tacrolimus for adult deceased donor liver transplantation (DDLT) patients. The aim of the present study was to evaluate the long-term efficacy and safety of generic tacrolimus compared to brand-name tacrolimus (Prograf ® ) in adult DDLT recipients. Methods: Two hundred sixty-five adult DDLTs were performed in our center between 2003 and 2017. To determine the efficacy and safety of generic tacrolimus, renal function (estimated glomerular filtration rate [eGFR] and creatinine), infectious complications, rejection-free survival rates, and patient survival rates were investigated. Results: Of 265 patients, 193 were selected and divided into a generic tacrolimus group (n=147) and a brand-name group (n=46). Mean follow-up duration was 63.2 ± 44.3 months. The 1-year, 3-year, 5-year, and 10-year patient survival rates were 89.1%, 86.9%, 84.5%, and 75.2%, respectively, in the generic tacrolimus group and 95.7%, 88.9%, 86.3%, and 83.7% in the brand-name tacrolimus group. There were no statistically significant differences in the infectious complications, new-onset diabetes, and renal dysfunction included mean serum creatinine level or eGFR after DDLT between the two groups. Increased recipient age, continuous renal replacement therapy (CRRT) in the pre-transplant phase, and acute rejection were predisposing factors for patient death.Conclusion: The present study shows that generic tacrolimus is an alternative comparable to brand-name tacrolimus in adult DDLT patients.

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“…In addition, a recent Korean cohort study of 9415 liver transplant recipients found that, when compared with patients aged 51 to 55 years, the risk for in‐hospital mortality among recipients older than 70 years was approximately 4‐fold higher . After adjusting for baseline liver disease and perioperative complications, the risk for death was nearly 3‐fold higher.…”

Section: Advanced Age Is Associated With Increased Post‐lt Mortalitymentioning

confidence: 99%

CON: Patients of Advanced Age Should Not Routinely Undergo Liver Transplantation

Kalra

Kriss

Francis

et al. 2019

Clinical Liver Disease

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Careful patient selection forms the foundation for improving patient outcomes after liver transplantation (LT). This also provides inherent selection bias in studies suggesting comparable post-LT outcomes in patients with advanced age compared with younger cohorts. • Despite this, studies from the United States, Europe, and Asia have demonstrated higher mortality in transplant recipients of advanced age. • Older transplant recipients in the United States are more likely to receive grafts from older donors. The use of organs from older donors (>60 years old) is associated with worse 5-year graft outcomes and increased 5-year mortality, further compounding the increased mortality in transplant recipients of advanced age. • Studies supporting the "pro" argument have significant limitations that preclude generalizability for most transplant centers.In the United States, the number of individuals older than 75 years is projected to double to more than 10% of the population by the year 2050, 1 and the question of whether to transplant patients of advanced age has thus become increasingly relevant. In practice, however, this is not a question of whether these patients deserve transplantation any more or less than younger patients. Nor is it a question of whether the transplant community is capable of successfully transplanting and caring for such a patient.After all, in the modern era of LT, overall 5-year graft and patient survival are each greater than 70% and continue to improve. 2 Although this is a testament to high-quality medical and surgical care of transplant registrants and recipients, the foundation for these outcomes is responsible allocation of donor organs via careful patient selection for transplantation. In that context, patients of advanced age (>70 years) should not routinely be considered appropriate candidates for LT.

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Recipient Age and Mortality After Liver Transplantation: A Population-based Cohort Study

Abstract: The data show that age remains an important risk factor for LT, suggesting that LT should be considered with caution in elderly recipients.

Cited by 70 publications

References 34 publications

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

<p>Generic Tacrolimus (Tacrobell<sup>®</sup>) Shows Comparable Outcomes to Brand-Name Tacrolimus in the Long-Term Period After Adult Deceased Donor Liver Transplantation</p>

CON: Patients of Advanced Age Should Not Routinely Undergo Liver Transplantation

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