Survival Outcomes in Liver Transplantation With Elderly Donors: Analysis of Andalusian Transplant Register

Franco, Carmen Cepeda; Bellido, C. Bernal; Barrera-Pulido, L.; Álamo-Martínez, J.M.; Ruiz-Matas, Jesús Huet; Suárez-Artacho, G.; Marín-Gómez, L.M.; Tinoco-González, José; Diaz-Aunion, C.; Padillo-Ruíz, Javier; Gómez‐Bravo, Miguel Ángel

doi:10.1016/j.transproceed.2016.09.026

Cited by 14 publications

(10 citation statements)

References 15 publications

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“…The presented results of outcomes after transplantation with a liver from an older donor are in accordance with results from other regions, although these are reported with a high variance. Reported patient survival rates at 1 year vary from 70% to 90% and 5‐year patient survival rates from 50% to 80% . The sometimes very promising outcomes are apparently contradicting to the higher intrinsic risk of older donors .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…In our study, these results were not confirmed when they were applied to recipients of grafts ≥ 70 years old, since we obtained a 5-year graft survival of 68.4% and 62.1% for D-MELD scores < 1600 and ≥ 1600, respectively ( P > 0.05). We also did not obtain significant differences when we used different cut-off points proposed by other authors[31,39], or by applying still different ones. Although D-MELD was an independent predictor of graft survival in our study, we think that it should be used in combination with other parameters to improve its prediction power.…”

Section: Discussionmentioning

confidence: 55%

“…It has been demonstrated that D-MELD is able to predict the results of LTs with donors older than 70 years, especially in HCV patients[31,39]. Initially, Halldorson et al[40] proposed a D-MELD score of 1600 as a cut-off point to identify cases with significantly worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors proposed that these grafts should be limited to young recipients without other associated risk factors to obtain better results[30,41,42]. However, in recent studies[13,26,31] the mean age of the recipients was even higher in the group of transplants performed with elderly donors than in the group of transplants performed with younger donors.…”

Section: Discussionmentioning

confidence: 99%

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Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

Caso-Maestro

Jiménez-Romero

Alonso

et al. 2018

WJG

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AIMTo increase the number of available grafts.METHODSThis is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation (LT) were performed with donors ≥ 70 years old (study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old (control group).RESULTSGraft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus (HCV)-positivity [hazard ratio (HR) = 2.35; 95% conﬁdence interval (CI): 1.55-3.56; P = 0.00]; recipient age (HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease (D-MELD) (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium (HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD (donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients (77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00).CONCLUSIONA DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.

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“…One of these is D-MELD, calculated as the product of the donor age and the recipient preoperative MELD (Model for End-Stage Liver Disease) score [89]. Data from the United States OPTN suggests worse outcomes with a D-MELD of greater than 1,600, whereas an analysis of patients in the Andalusian Transplant Registry found a preferred cutoff to be a D-MELD of 1,500 [90]. Regardless of the predictive scoring system used, donor age remains one of the dominant factors in predicting outcomes.…”

Section: Prognostic Scoring Of Donor Organsmentioning

confidence: 99%

Elderly Donors in Transplantation

Gilmore¹,

Barbas²

2020

Principles and Practice of Geriatric Surgery

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The disparity between supply and demand of donor organs remains a major limitation in the field of transplantation. Increased utilization of organs from older donors has significant potential to expand the pool of donor organs; however, utilization of such organs has been limited both in the United States and internationally. Accumulating evidence demonstrates that the use of organs from well-selected older donors produces acceptable patient and graft survival. As donor and recipient selection

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Survival Outcomes in Liver Transplantation With Elderly Donors: Analysis of Andalusian Transplant Register

Cited by 14 publications

References 15 publications

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

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

Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

Elderly Donors in Transplantation

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