The impact of donor age on liver transplantation: Influence of donor age on early liver function and on subsequent patient and graft survival
ABSTRACT 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.
- SourceAvailable from: Reza F Saidi
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- "Therefore, given these later results, age, itself, should not be a contraindication to liver donation. However, a recent study  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 . "
ABSTRACT: Improvements in surgical techniques, immunosuppression, and post-transplantation patient care have led to the optimization of liver transplantation outcomes. However, the waiting list for liver transplantation is increasing at a greater pace. The large gap between the growing pool of patients waiting for liver transplantation and the scarcity of donor organs has fueled efforts to maximize existing donors and identify new sources. This article will be focused on the current state of liver transplantation using grafts from extended criteria donors (elderly donors, steatotic donors, donors with malignancies, donors with viral hepatitis) and from donation after cardiac death (DCD), as well as the use of partial grafts (split grafts and living-donor liver transplantation) and other suboptimal donors (donors with hypernatremia, infections, hypotension and inotropic support). Overall, broadened criteria for acceptable donor livers appear to lessen graft survival rates somewhat compared with rates for standard criteria organs.International Journal of Organ Transplantation Medicine 05/2013; 4(2):46-59.
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- "Bone marrow transplantation from older donors affects patient survival . Liver transplants from older donors (N70 years) are associated with increased mortality  and patient mortality decreases when younger heart donors are used . Lastly, kidney transplants may be influenced by donor age  and diminished functional reserves in kidneys from older donors are observed . "
ABSTRACT: Given the duration of ageing in humans, cell culture studies are a promising approach to the study of human ageing. It is reasonable to assume that human ageing has, at least partly, a cellular origin. The question is how we can replicate in vitro the age-related changes that occur in human cells in vivo. In this review, widely used models for studying ageing in cell culture, such as Hayflick's, are interpreted in the context of the human ageing process. The mechanisms behind cellular senescence such as telomere disruption and DNA damage are reviewed and their relation to human ageing debated. A system-level examination of these mechanisms suggests that cell culture models are useful for studying cancer and certain age-related pathologies. There is little evidence, however, that cellular senescence is a significant factor in human ageing or that the mechanisms responsible for in vitro cellular senescence are a causative factor in human ageing in vivo. Therefore, novel approaches for studying human ageing at a cellular level are necessary and some suggestions are put forward.Experimental Cell Research 11/2004; 300(1):1-10. DOI:10.1016/j.yexcr.2004.07.006 · 3.37 Impact Factor
- "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 . "