Recipient age affects long-term outcome and hepatitis C recurrence in old donor livers following transplantation

Authors

  • Markus Selzner,

    1. Department of General Surgery, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Arash Kashfi,

    1. Department of General Surgery, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Nazia Selzner,

    1. Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Stuart McCluskey,

    1. Department of Anesthesia, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Paul D. Greig,

    1. Department of General Surgery, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Mark S. Cattral,

    1. Department of General Surgery, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Gary A. Levy,

    1. Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Les Lilly,

    1. Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Eberhard L. Renner,

    1. Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • George Therapondos,

    1. Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Lesley E. Adcock,

    1. Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • David R. Grant,

    1. Department of General Surgery, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
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  • Ian D. McGilvray

    Corresponding author
    1. Department of General Surgery, Toronto General Hospital, Toronto, Ontario, Canada
    2. Division of Multiorgan Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
    • Toronto General Hospital, NCSB 11C-1250, 585 University Avenue, Toronto, ON, Canada M5G2N2
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    • Telephone: 1-416-340-5230; FAX: 1-416-340-5242


Abstract

We studied the role of donor and recipient age in transplantation/ischemia-reperfusion injury (TIRI) and short- and long-term graft and patient survival. Eight hundred twenty-two patients underwent deceased donor liver transplantation, with 197 donors being ≥60 years old. We evaluated markers of reperfusion injury, graft function, and clinical outcomes as well as short- and long-term graft and patient survival. Increased donor age was associated with more severe TIRI and decreased 3- and 5-year graft survival (73% versus 85% and 72% versus 81%, P < 0.001) and patient survival (77% versus 88% and 77% versus 82%, P < 0.003). Hepatitis C virus (HCV) infection and recipient age were the only independent risk factors for graft and patient survival in patients receiving an older graft. In the HCV(+) cohort (297 patients), patients ≥ 50 years old who were transplanted with an older graft versus a younger graft had significantly decreased 3- and 5-year graft survival (68% versus 83% and 64% versus 83%, P < 0.009). In contrast, HCV(+) patients < 50 years old had similar 3- and 5-year graft survival if transplanted with either a young graft or an old graft (81% versus 82% and 81% versus 82%, P = 0.9). In conclusion, recipient age and HCV status affect the graft and patient survival of older livers. Combining older grafts with older recipients should be avoided, particularly in HCV(+) patients, whereas the effects of donor age can be minimized in younger recipients. Liver Transpl 15:1288–1295, 2009. © 2009 AASLD.

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