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

Authors

  • Matteo Cescon,

    Corresponding author
    1. Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
    • Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
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    • Telephone: +39-51-6364810; FAX: +39-51-304902

  • Gian Luca Grazi,

    1. Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Alessandro Cucchetti,

    1. Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Matteo Ravaioli,

    1. Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Giorgio Ercolani,

    1. Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Marco Vivarelli,

    1. Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Antonietta D'Errico,

    1. Department of Oncology and Hematology, Pathology Division of the “Felice Addarii” Institute, University of Bologna, Bologna, Italy
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  • Massimo Del Gaudio,

    1. Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Antonio Daniele Pinna

    1. Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
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Abstract

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 = 173): <50 years; group 2 (n = 96): 50–59 years; group 3 (n = 132): 60–69 years; group 4 (n = 111): 70–79 years; group 5 (n = 41): ≥80 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 > 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 = 0.01 and P = 0.001, respectively) and in group 5 (81%) versus groups 3 and 4 (P = 0.04 and P = 0.01, respectively). Donor age of 60–79 years, recipient hepatitis C virus–positive status, Model for End-Stage Liver Disease score ≥ 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 = 0.04; group 2 versus group 3, P = 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. Liver Transpl, 2008. © 2008 AASLD.

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