Long-Term Results Using Old Liver Grafts for Transplantation: Sexagenerian Versus Liver Donors Older than 70 Years

Abstract

Background

The most practical measure to augment the available number of liver grafts and thus reduce waiting list mortality is to increase the donor age limit. We hypothesized that with careful selection of old liver donors without age limit it should be possible to obtain good patient and graft survival.

Methods

The present study comprises 351 adults who underwent liver transplantation. They were divided into three groups according to the age of the liver donors: group 1: 226 recipients of donors <60 years; group 2: 75 recipients of donors between 60 and 70 years; and group 3: 50 recipients of donors >70 years. A comparative study among the groups was performed.

Results

Patient survival rates at 1, 3, and 5 years were, respectively, 81.0, 76.1, and 71.1 % in group 1; 83.8, 74, and 72.2 % in group 2; and 76, 70.0, and 62.9 % in group 3 (P = NS). Graft survival at 1, 3, and 5 years was, respectively, 74.8, 69.0, and 64.1 % in group 1; 82.7, 71.4, and 69.6 % in group 2; and 71.4, 64.8, and 58.3 % in group 3 (P = NS). We analyzed the use of older grafts in recipients with HCV cirrhosis and did not find significant differences in patient and graft survival at 1, 3, and 5 years. In multivariate analysis increased donor body mass index and decreased recipient albumin were associated with lower patient and graft survival.

Conclusions

Because patient and graft survival rates are not affected by donor age, well-selected older donor livers can be safely used if they show good function and preharvesting conditions.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CIT:

Cold ischemia time

FFP:

Fresh frozen plasma

GGT:

Gamma-glutamyl transpeptidase

GOT:

Glutamic oxaloacetic transaminase

GPT:

Glutamic pyruvic transaminase

HBV:

Hepatitis B virus

HCC:

Hepatocarcinoma

HCV:

Hepatitis C virus

HR:

Hazard ratio

ICU:

Intensive care unit

IPF:

Initial poor function

OLT:

Ortothopic liver transplantation

PNF:

Primary nonfunction

PRBC:

packed red blood cells

WIT:

Warm ischemia time

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Acknowledgments

The authors thank Javier de la Cruz and David Lora for contributions to the statistical analysis. We also thank Dr. M. Abradelo, Dr. F. Cambra, and Dr. F. Colina for collaboration in this article.

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Correspondence to Carlos Jiménez-Romero.

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Jiménez-Romero, C., Clemares-Lama, M., Manrique-Municio, A. et al. Long-Term Results Using Old Liver Grafts for Transplantation: Sexagenerian Versus Liver Donors Older than 70 Years. World J Surg 37, 2211–2221 (2013). https://doi.org/10.1007/s00268-013-2085-7

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Keywords

  • Graft Survival
  • Intensive Care Unit Stay
  • Orthotopic Liver Transplantation
  • Chronic Rejection
  • Liver Graft