The impact of donor age on liver transplantation: Influence of donor age on early liver function and on subsequent patient and graft survival

Department of Surgery, Hospital Princeps d'Espanya, C/Feixa llarga s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain.
Transplantation (Impact Factor: 3.83). 07/2001; 71(12):1765-71. DOI: 10.1097/00007890-200106270-00011
Source: PubMed


The urgent need to increase the organ donor pool has led to the expansion of criteria for donor selection. The aim of this study was to analyze the influence of donor age on early graft function, subsequent graft loss, and mortality after liver transplantation (LT).
Data on LT were evaluated retrospectively in a population-based cohort of 400 LTs in 348 patients. Of these, 21 (5%) were from donors >70 years old. Pretransplantation donor and recipient characteristics and the evolution of recipients were analyzed. The influence of donor age as a risk factor was assessed using univariate and multivariate analyses.
Actuarial graft survival was 89% at 1 month after LT, 81% after 6 months, and 59% after 60 months. Multivariate analysis demonstrated that only donor age (>70 years old) was associated with a higher risk of long-term graft loss (relative risk [RR]=1.4, 95% confidence interval [CI]=1-1.9; P=0.03) and mortality (RR=1.7, 95% CI=1.2-2.3; P=0.01). Graft survival of septuagenarian livers was 80% at 1 month after LT, 56% after 6 months, and 25% after 54 months. Actuarial survival analysis (Kaplan-Meier curves) also demonstrated worse evolution in recipients of livers from old donors (log-rank test, P<0.001).
Advanced donor age is associated with lower graft and recipient survival.

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    • "Therefore, given these later results, age, itself, should not be a contraindication to liver donation. However, a recent study [30] reported that liver grafts from donors >70 years of age had a relative risk of 1.4 and 1.7 for long-term graft failure and mortality, respectively. More recent studies using the large databases of either SRTR/United Network for Organ Sharing (UNOS) or European Liver Transplantation Registry (ELTR) clearly identified donor age as an important risk factor for poor outcome after LT [31]. "
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    • "Bone marrow transplantation from older donors affects patient survival [78]. Liver transplants from older donors (N70 years) are associated with increased mortality [79] and patient mortality decreases when younger heart donors are used [80]. Lastly, kidney transplants may be influenced by donor age [81] and diminished functional reserves in kidneys from older donors are observed [82]. "
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    • "Sin embargo en la mayoría de los trabajos el desarrollo de trombosis portal o de la arteria hepática no es mayor en los donantes de edad avanzada ( Hoofnagle et al , 1996 . Busquets et al , 2001 . Gómez et al , 1993 . "
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