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Liver transplantation with donors over the expected lifespan in the model for end-staged liver disease era: is Mother Nature punishing us?


Prof Dr Georgios C. Sotiropoulos, MD, FACS, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, 45122 Essen, Germany
Tel: +0049 201 72384002
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Background: The lack of sufficient donors to satisfy the waiting list requirements has prompted many to expand the acceptance criteria. The purpose of this study was to evaluate our liver transplantation (LT) experience with donors beyond the average lifespan.

Patients and methods: From January 2008 to December 2009, we received 75 liver offers involving donors ≥75 years of age. Donor and recipient data were analysed by both uni- and multivariate Cox proportional hazard model analyses.

Results: We performed 32 adult liver transplants (43%). Half of the patients received organs through rescue allocations. Seven recipients (22%) developed initial poor function. Two had primary graft non-function (PNF). Four recipients were re-transplanted (two PNF and two ischaemic-type bile lesions). One- and 3-year cumulative survival was 62 and 51% respectively. PNF, lab model for end-staged liver disease (MELD), post-LT haemodialysis, post-LT re-operations and post-LT sepsis were significant predictors by univariate analysis. Only PNF reached multivariate significance (P=0.0307). Rescue offer allocation reached significance as a predictor of PNF by general linear model forward analysis. One- and 3-year ‘MELD based allocation’ (n=16) vs ‘rescue allocation’ (n=16) survival rates were 44 and 29% vs 82 and 76% respectively (P=0.0197).

Conclusions: Although grafts from donors ≥75 years allow for an expansion of the donor pool, long-term recipient survival is inferior to that encountered with younger donors. Acceptable results could be obtained by identifying ‘preferred’ recipients for rescue allocations.