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Graft function and outcome of older (> or = 60 years) donor livers
W K Washburn1, L B Johnson, W D Lewis
1Division of Liver Transplantation and Heptobiliary Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, Massachutts 02215, USA.
Insights
Older donor livers (≥60 years) show similar initial function but worse long-term survival in liver transplantation. Careful evaluation is crucial, as age alone shouldn't preclude use, but caution is advised for older donor grafts.
Area of Science:
- Hepatology
- Transplantation Surgery
- Organ Donation
Background:
- Liver grafts from donors aged 60 years or older are often deemed unsuitable for transplantation.
- Extended waiting times necessitate the utilization of older donor organs.
Purpose of the Study:
- To evaluate the outcomes of liver transplantation using older donor grafts (≥60 years) compared to younger donors (<60 years).
- To assess the impact of donor age on initial graft function and long-term patient and graft survival.
Main Methods:
- Retrospective analysis of 223 liver transplants between 1990-1994.
- Comparison of grafts from donors ≥60 years (Group A, n=29) versus <60 years (Group B, n=194).
- Matching for recipient diagnosis, disease severity, and donor characteristics (liver, renal, hematologic studies, weight, sex, race, vasopressor use).
Main Results:
- Initial postoperative liver function tests (ALT, AST, PT) were similar between groups.
- Older donor grafts (Group A) showed significantly higher cholestasis on postoperative days 6-10.
- One-year patient survival was 58.6% (Group A) vs. 79.2% (Group B), and graft survival was 44.8% vs. 74.5% (P<0.001).
- Retransplantation rates for primary nonfunction were not significantly different (6.7% vs. 3.4%).
Conclusions:
- Initial function of older donor livers is comparable to younger donors, but long-term survival is significantly worse.
- Donor age alone should not be a sole criterion for discarding livers; inspection and biopsy are recommended.
- Cautious use of older donor liver grafts in healthier recipients is recommended due to poorer survival outcomes.
Abstract:
Livers from donors > or = 60 years of age are often considered inadequate for transplantation by many centers. With waiting times exceeding 1 year in our region, we have aggressively used livers from this donor age group. Between 1990 and 1994, 209 patients received 223 liver grafts at our institution. Of these, 29 (13%) were from donors > or = 60 years of age (group A) and 194 (87%) were from donors < 60 years of age (group B). The two groups were matched for recipient diagnosis and severity of disease. Group A and B donors had similar liver, renal, and hematologic studies prior to donation. Weight, sex, race and vasopressor requirement were also similar. Postoperative alanine aminotransferase, aspartate aminotransferase,and prothrombin time were not significantly different over the first 10 postoperative days. Group A grafts were significantly more cholestatic than group B grafts on postoperative days 6-10. The retransplantation rate for primary graft nonfunction was not significantly different from group A (6.7%) and group B (3.4%; P=0.04). Patient and graft survival rates at 1 year were 58.6 % and 44.8% for group A and 79.2% and 74.5% for group B (P<0.001 for both). Four of 12 deaths in the first year in group A were completely unrelated to graft function. If these are excluded, patient and graft survival rates were 68% and 52%, which are better but still significantly less than in group B. Initial graft function of older donor livers are similar to that of the matched younger group. However, patient and graft survival rates were significantly worse for the older donors, even when corrected for unrelated deaths. Livers should not be discarded based on age alone without inspection and/or biopsy to rule out significant steatosis. Prompt retransplantation for primary graft nonfunction of older donors are generally more cholestatic than those from the younger donor age group; however, many of them function quite well. At the present time, given the inability to identify donor variables associated with decreased recipient survival, we recommend cautious use of older liver grafts in healthier recipients.