Improving the outcome of liver transplantation with very old donors with updated selection and management criteria

✍ Scribed by Matteo Cescon; Gian Luca Grazi; Alessandro Cucchetti; Matteo Ravaioli; Giorgio Ercolani; Marco Vivarelli; Antonietta D'Errico; Massimo Del Gaudio; Antonio Daniele Pinna

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 215 KB
• Volume: 14
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21433

✦ Synopsis

Advanced donor age is a risk factor for poor outcome in liver transplantation (LT). We reviewed 553 consecutive transplants according to donor age categories [group 1 (n ϭ 173): Ͻ50 years; group 2 (n ϭ 96): 50-59 years; group 3 (n ϭ 132): 60-69 years; group 4 (n ϭ 111): 70-79 years; group 5 (n ϭ 41): Ն80 years]. Clinical parameters were comparable between groups. Group 5 had the highest proportion of pretransplant liver biopsy (85%), with only 1 graft showing macrovesicular steatosis Ͼ 30%, and the lowest ischemia time. Five-year graft survival was significantly higher in group 1 (75%) versus groups 3 (60%) and 4 (62%; P ϭ 0.01 and P ϭ 0.001, respectively) and in group 5 (81%) versus groups 3 and 4 (P ϭ 0.04 and P ϭ 0.01, respectively). Donor age of 60-79 years, recipient hepatitis C virus-positive status, Model for End-Stage Liver Disease score Ն 25, and emergency LT were predictors of poor survival. In hepatitis C virus-positive patients, 5-year graft survival was 72% in group 1, 85% in group 2, 52% in group 3, 65% in group 4, and 71% in group 5 (group 1 versus group 3, P ϭ 0.04; group 2 versus group 3, P ϭ 0.03). In conclusion, older donor grafts managed with routine graft biopsy and short ischemia time may work effectively, regardless of the severity of the recipient's liver disease.