Selective Use of Older Adults in Right Lobe Living Donor Liver Transplantation

Abstract

Many centers are reluctant to use older donors (>44 years) for adult right-lobe living donor liver transplantation (RLDLT) due to concerns about possible increased morbidity in donors and poorer outcomes in recipients. Since 2000, 130 adult RLDLTs have been performed at our institution. Recipients were divided into those who received a right lobe graft from a donor ≤age 44 (n = 89, 68%; median age 30) and those who received a liver graft from a donor age >44 (n = 41, 32%; mean age 52). The two donor and recipient populations had similar demographic and operative profiles. With a median follow-up of 29 months, the severity and number of complications in older donors were similar to those in younger donors. No living donor died. Older donor allografts had initial allograft dysfunction compared to younger donors. Complication rates were similar among recipients in both groups but there was a higher bile duct stricture rate with older donor grafts (27% vs. 12%; p = 0.04). One-year recipient graft survival was 86% for older donors and 85% for younger donors (p = 0.95). Early experience with the use of selected older adults (>44 years) for RLDLT is encouraging, but may be associated with a higher rate of biliary complications in the recipient.

Donor safety in living donor liver donation: An Italian multicenter survey

“…Our data showed a midway incidence of major donor complications of 12.6% in the range of 2%‐32% reported by other series including those where outcomes were evaluated with a different Clavien grading system, with a rate of ≥3 Clavien complications estimated at approximately 20%‐25% . Nevertheless, data from large Far Eastern centers with the lowest recipient morbidity and best survival rates also report the lowest incidence of donor ≥3 Clavien complications at < 10% .…”

“…Nevertheless, data from large Far Eastern centers with the lowest recipient morbidity and best survival rates also report the lowest incidence of donor ≥3 Clavien complications at < 10% . According to the data reported by the A2ALL study group and the Toronto group, a range from 2% to 5% could be considered the definitive risk of intraoperative aborted living RL donation . Our survey found a lower rate of no‐go hepatectomies with only 1 (1/247, 0.4%) donor procedure being aborted.…”

Complications of right lobe living donor liver transplantation

“…It is noteworthy that the large Asian centers with the lowest recipient morbidity and best survival [21,23,24,40] also had the smallest incidence of donor ≥III Clavien complications (4.9–9%) [37–40]. Although donor studies by the Toronto group [44] and by the A2ALL consortium [45] were done with the 4-tier system, enough detail was provided to estimate an approximately 20–25% rate of ≥III Clavien complications.…”

Live donor liver transplantation: Current status

“…There was a 41% higher risk of graft failure with each 10-year increase in recipient age (P = 0.0008) [14••]; however, the advanced age-related increase was not significant. In fact, two recent studies have reported data suggesting that advanced donor age is not correlated with increased graft failure, although one study used age 44 as a cutoff for advanced age [15] and the other reported on experience with only 23 patients older than age 60 [16]. Regardless, the younger age of most living donors may limit the power to study this question.…”