Use of Elderly Donors in Liver Transplantation

Ghinolfi, Davide; Lai, Quirino; Pezzati, Daniele; Simone, Paolo De; Rreka, Erion; Filipponi, Franco

doi:10.1097/sla.0000000000002305

Cited by 58 publications

(32 citation statements)

References 31 publications

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“…We identified a history of diabetes, prolonged CIT, rescue allocation, male sex, MELD score category, and HCV positive in the recipient as risk factors for decreased outcome of LT with older livers. This is in line with the factors that were identified by Ghinolfi et al including a history of diabetes . Diabetes is more often present in older donors and may have a stronger and more chronic effect on the vasculature and parenchyma in older donor livers .…”

Section: Discussionsupporting

confidence: 89%

“…This is in line with the factors that were identified by Ghinolfi et al including a history of diabetes . Diabetes is more often present in older donors and may have a stronger and more chronic effect on the vasculature and parenchyma in older donor livers . Diabetes, therefore, seems to be an important risk factor that should be avoided when possible.…”

Section: Discussionsupporting

confidence: 87%

“…When evaluating patient selection criteria, analyses are likely to confirm “classical” selection patterns for older donors. These livers are generally accepted for older recipients with lower laboratory MELD scores who more often suffer from malignant disease . This previously observed selection bias is inherent to the retrospective design and was also observed in this study: livers of donors of 70 years and older had shorter ischemia times, had diabetes less often, and underwent transplantation in recipients with lower laboratory MELD scores.…”

Section: Discussionmentioning

confidence: 68%

“…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 . These results are therefore likely to be explained by the frequent single‐center design, relatively small numbers of included transplantations, different aging patterns in other countries, and differences in recipient and donor selection criteria.…”

Section: Discussionmentioning

confidence: 99%

“…The demographical transition in Western countries with aging populations and promising posttransplantation results indicates that this practice will become increasingly more common. The current substantial use might therefore just be the onset of a far more common one in Europe and the United States .…”

mentioning

confidence: 99%

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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: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2019

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Utilization of older deceased donors for pediatric liver transplant may negatively impact long‐term survival

Kulkarni,

Vachharajani,

Hill

et al. 2023

J. pediatr. gastroenterol. nutr.

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BackgroundMultiple adult studies have investigated the role of older donors (ODs) in expanding the donor pool. However, the impact of donor age on pediatric liver transplantation (LT) has not been fully elucidated.MethodsUNOS database was used to identify pediatric (≤18 years) LTs performed in the United States during 2002–22. Donors ≥40 years at donation were classified as older donors (ODs). Propensity analysis was performed with 1:1 matching for potentially confounding variables.ResultsA total of 10,024 PLT patients met inclusion criteria; 669 received liver grafts from ODs. Candidates receiving OD liver grafts were more likely to be transplanted for acute liver failure, have higher MELD/PELD scores at LT, listed as Status 1/1A at LT, and be in the intensive care unit (ICU) at time of LT (all p < 0.001). Kaplan–Meier (KM) analyses showed that recipients of OD grafts had worse patient and graft survival (p < 0.001) compared to recipients of younger donor (YD) grafts. KM analyses performed on candidates matched for acuity at LT revealed inferior patient and graft survival in recipients of deceased donor grafts (p < 0.001), but not living donor grafts (p > 0.1) from ODs. Cox regression analysis demonstrated that living donor LT, diagnosis of biliary atresia and first liver transplant were favorable predictors of recipient outcomes, whereas ICU stay before LT and transplantation during 2002–12 were unfavorable.ConclusionLivers from ODs were used for candidates with higher acuity. Pediatric recipients of livers from ODs had worse outcome compared to YDs; however, living donor LT from ODs had the least negative impact on recipient outcomes.

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Pushing the donor limits: Deceased donor liver transplantation using organs from octogenarian donors

Jaime

Berenguer

2017

Liver Transpl

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Use of Elderly Donors in Liver Transplantation

Abstract: Use of elderly donors is not associated per se with an increased risk of vascular and biliary complications. In the presence of cold ischemia time and diabetes mellitus, appropriate donor-to-recipient matching is warranted.

Cited by 58 publications

References 31 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

Utilization of older deceased donors for pediatric liver transplant may negatively impact long‐term survival

Pushing the donor limits: Deceased donor liver transplantation using organs from octogenarian donors

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