Safe Use of Hepatic Allografts From Donors Older Than 70 Years1

Abstract

Between March 1991 and August 1995, 36 livers from donors >/=70 years old were transplanted. In donors, we recorded the following risk factors: alanine aminotransferase > 120 and rising, dopamine dose > 15 microg/kg/min, hypotension (systolic blood pressure <80) >1 hr, stay in the intensive care unit >5 days and body mass index >/=27. In 35 recipients, we recorded pretransplant United Network for Organ Sharing (UNOS) status, cold/warm ischemia time, intraoperative blood loss, and occurrence of poor early graft function or primary nonfunction. Mean recipient age was 55 years (range, 25-75 years). Four recipients were UNOS status 1, 19 were UNOS 2, and 12 were UNOS 3. Two livers were used as second grafts for primary graft nonfunction. Mean donor age was 73 years (range, 70-84 years). Intracranial bleeding was the cause of death in the majority of donors. The 36 donors had 40 risk factors; 10 donors had >1 risk factor. Mean cold and warm ischemia times were 9:08 +/- 2:57 hr and 51 +/- 9 min. Mean total operative time was 7.5 hr. Posttransplant mean peak alanine aminotransferase and aspartate aminotransferase levels were 937.3 +/- 703.1 IU/L and 923.3 +/- 708.5 IU/L, respectively. Mean prothrombin time on postoperative day 2 was 14.9 +/- 1.6 sec. Average total bilirubin on postoperative day 5 was 4.9 mg/dl. Median length of stay in the intensive care unit was 4 days. One recipient had poor early graft function; two recipients had primary nonfunction. Mean follow-up was 503 days (range, 110-1714 days). Three-month actual graft and patient survival rates were 85% and 91%, respectively. One-year actuarial graft and patient survival rates were also 85% and 91%, respectively. We conclude that older livers can be used safely. Advanced donor age should not be a contraindication to liver procurement.

A Revised Consideration on the Use of Very Aged Donors for Liver Transplantation

“…A progressive growth of cholestatic indexes, accompanied by simultaneously decreasing cytolitic activity, is a common and already described finding (4,16,19,21), with a significant influence on survival rates (21). Although a similar course was observed in some of our cases, this did not seem to determine differences in p.o.…”

“…Recent series of OLTs performed with the use of donors older than 60 years old (3)(4)(5)16,17) and, in one case, an 87-year-old (7), show that graft recovery can be satisfactory. donors below the age of 50 yr, showing no substantial differences in terms of liver function recovery, incidence of PGNF or retransplantation and graft survival up to 6 months.…”

Late liver function with graft obtained from donors above 65 years

“…3 Patient and graft survival rates were 88% and 83% respectively, also very similar to those obtained with young livers. 1,2 Although the rate of surgical complications was similar in both groups, and none of the sepsis complications previously described were observed, it was noted that the arterial thrombosis only occurred with old liver grafts, and that was caused by technical problems and not by graft arterial damage. 8 The present clinical study demonstrates good long-term results obtained with liver grafts from elderly donors, with times of ischemia close to 6 hours, and proves the suitability of these donors for any type of recipient, beyond their previous restriction to critical transplant patients.…”

“…The consideration of these facts, together with the aging of population and the reduced number of liver donors available, have resulted in the use of elder donors. [1][2][3][4] Although the early function of grafts from donors above 65 years of age has been proven to be as good as that obtained with grafts from young donors, 1,5 their late function is less known. …”

Potential utility of xenobiotic mitogens in the context of liver regeneration in the elderly and living-related transplantation

“…2 The impact of age of a cadaveric or living donor on the outcome of liver transplantation and the results of liver resection in the elderly patients have been evaluated in only a few clinical studies and are subject to considerable discussion. Although one study failed to show any significant difference, 3 others have suggested an increased risk for primary non-function in liver transplant recipients receiving a graft from older donors. [4][5][6] In this context, it is of interest to note that a major characteristic of the aging process is a decline in the cellular capacity to respond to proliferative stimuli.…”