Related Experiment Video
Updated: May 23, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
How can we utilize livers from advanced aged donors for liver transplantation for hepatitis C?
Tadahiro Uemura1, Lucas E Nikkel, Christopher S Hollenbeak
1Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA. tuemura@hmc.psu.edu
Insights
Advanced aged donor liver grafts show inferior survival in Hepatitis C (HCV) patients. Grafting these organs into younger or low Model for End-Stage Liver Disease (MELD) patients did not improve outcomes, suggesting careful selection is needed.
Area of Science:
- Hepatology
- Transplantation Immunology
- Geriatric Medicine
Background:
- Advanced age donor liver grafts are associated with poorer outcomes in liver transplantation for Hepatitis C (HCV).
- The strategy of transplanting aged donor grafts into younger or low Model for End-Stage Liver Disease (MELD) recipients to mitigate donor age effects is not fully understood for HCV patients.
Purpose of the Study:
- To analyze the outcomes of liver transplantation using advanced aged donor grafts (≥ 60 years) in Hepatitis C (HCV) patients.
- To identify risk factors for graft failure and survival in HCV patients receiving grafts from advanced aged donors.
Main Methods:
- Retrospective analysis of 7508 primary liver transplantation cases from the UNOS database for HCV patients.
- Utilized Cox hazards models, Donor Risk Index (DRI), and Organ-Patient Index (OPI) to assess graft survival and risk factors.
- Stratified analysis based on recipient age, MELD score, and donor characteristics including Donation after Cardiac Death (DCD).
Main Results:
- Recipient age did not influence graft survival, irrespective of donor age.
- Advanced aged grafts demonstrated significantly inferior graft survival compared to younger grafts (P < 0.0001), independent of MELD score.
- Risk factors for graft failure in HCV patients receiving advanced aged grafts included Donation after Cardiac Death (DCD) and recent recipient hospitalization.
Conclusions:
- Transplanting advanced aged donor liver grafts into younger or low MELD HCV patients does not offset the negative impact of donor age on graft survival.
- Advanced aged grafts, particularly those from DCD donors, require judicious use in HCV patients, especially those with lower MELD scores.
- Graft survival using advanced aged grafts varied significantly when stratified by DRI and OPI, highlighting the need for careful donor-recipient matching.
Abstract:
Advanced age donors have inferior outcomes of liver transplantation for Hepatitis C (HCV). Aged donors grafts may be transplanted into young or low model for end stage liver disease (MELD) patients in order to offset the effect of donor age. However, it is not well understood how to utilize liver grafts from advanced aged donors for HCV patients. Using the UNOS database, we retrospectively studied 7508 HCV patients who underwent primary liver transplantation. Risk factors for graft failure and graft survival using advanced aged grafts (donor age ≥ 60 years) were analyzed by Cox hazards models, donor risk index (DRI) and organ patient index (OPI). Recipient's age did not affect on graft survival regardless of donor age. Advanced aged grafts had significant inferior survival compared to younger aged grafts regardless of MELD score (P < 0.0001). Risk factors of HCV patients receiving advanced aged grafts included donation after cardiac death (DCD, HR: 1.69) and recent hospitalization (HR: 1.43). Advanced aged grafts showed significant difference in graft survival of HCV patients with stratification of DRI and OPI. In conclusion, there was no offsetting effect by use of advanced aged grafts into younger or low MELD patients. Advanced aged grafts, especially DCD, should be judiciously used for HCV patients with low MELD score.
