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Published on: August 17, 2022
Octogenarian Donors in Liver Transplantation
M Gastaca1, M Guerra2, L Alvarez Martinez3
1Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Bilbao, Spain; Hepatobiliary Surgery and Liver Transplantation Unit, University of the Basque Country, Bilbao, Spain.
Insights
Liver transplantation using donors aged 80 and above shows excellent outcomes. Strict donor selection and graft allocation are key to successful liver transplant procedures with elderly donors.
Area of Science:
- Hepatology
- Transplantation Surgery
- Geriatric Medicine
Background:
- Increasing organ donor shortages necessitate the use of older donors for liver transplantation.
- Octogenarian donors (aged 80+) are increasingly considered to meet recipient demand.
Purpose of the Study:
- To evaluate the outcomes of liver transplantation utilizing donors aged 80 years and older.
- To assess the safety and efficacy of using grafts from octogenarian liver donors.
Main Methods:
- Retrospective analysis of 33 liver transplantations using donors aged 80+ from 2003-2016.
- Donor selection criteria included preoperative liver function, hemodynamic stability, and intraoperative appearance.
- Grafts were excluded for retransplantation or recipients with complex surgical histories.
Main Results:
- Mean donor age was 82.7 years; 9.1% had a history of diabetes.
- Graft survival at 1 and 3 years was 92.6% and 86.4%, respectively.
- Low rates of primary nonfunction (0%), hepatic artery thrombosis (3%), and biliary complications (12.5%) were observed.
Conclusions:
- Liver transplantation with octogenarian donors can achieve excellent mid-term results.
- Strict donor selection protocols and appropriate graft allocation are crucial for successful outcomes.
Introduction:
Due to the disparity between the number of patients on the list for liver transplantation and the availability of organs, the use of older donors has become necessary. The aim of this study was to investigate the outcomes of liver transplantation using octogenarian donors.
Methods:
From December 2003 to February 2016, 777 liver transplantations were performed at our institution, 33 of them (4.2%) with donors 80 years old and above. Our policy for the acceptance of these donors is based on preoperative liver function tests, donor hemodynamic stability, and intraoperative normal gross aspect. Octogenarian grafts were deliberately not assigned to retransplantations or to recipients with multiple previous surgical procedures or extensive portal thrombosis.
Results:
Mean donor age was 82.7 ± 2.1 years, with a range between 80 and 88. Only 12.1% suffered hemodynamic instability during the intensive care unit stay. Three donors (9.1%) had a history of diabetes mellitus. The mean Model for End-Stage Liver Disease score among recipients was 14.7 ± 5.6. Mean cold ischemia time was 302 ± 61 minutes. After a median follow-up of 18.5 months (range 7.5 to 47.5), no graft developed primary nonfunction. We observed hepatic artery thrombosis in 1 patient (3%) and biliary complications in 4 patients (12.5%). There was 1 case of ischemic-type biliary lesion, although it was related to hepatic artery thrombosis. Patient survival at 1 and 3 years was 90.3%, whereas graft survival was 92.6% and 86.4%, respectively.
Conclusions:
Excellent mid-term results can be obtained after liver transplantation with octogenarian donors with strict donor selection and adequate graft allocation.
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