Older liver graft transplantation, cholestasis and synthetic graft function.

Department of General, Visceral and Transplant Surgery, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Berlin, Germany.
Transplant International (Impact Factor: 3.16). 07/2005; 18(6):709-15. DOI: 10.1111/j.1432-2277.2005.00128.x
Source: PubMed

ABSTRACT Older liver grafts are often discarded because of conservative selection criteria. We report on our clinical experience with graft-age related outcome. Patients transplanted with livers older than 70 years (70.2-80.2 years, n = 38) were compared with controls transplanted with livers younger than 70 years. Pairs were matched for age, gender, indication and cold ischemic time. Mean donor age was 73.4 +/- 2 vs. 39 +/- 16 years. Patient and graft survival did not differ between both groups after 1-year follow-up (P = 0.19 and P = 0.24 respectively). Retransplantation rate was 10.5% vs. 5.3% (P = 0.40). Initial poor function occurred in two patients in the study group versus four patients in the control group (P = 0.69). The incidence of rejection episodes was comparable. Parameters of cholestasis and protein synthesis showed no difference 1-year post-transplant. Mean age of donor organs in matched pairs group B was near by half of that in the older donor group A (39.0 vs. 73.4 years). Post-transplant outcome as indicated by patient and graft survival was comparable between both groups. Donor organ age had no impact on postoperative organ function. We recommend to accept liver grafts from organ donors older than 70 years to expand the donor pool.

  • [Show abstract] [Hide abstract]
    ABSTRACT: In der Lebertransplantation spielt angesichts der großen Knappheit an Spenderorganen die Verwendung marginaler Organe eine wichtige Rolle. Der Begriff „marginale Spender“ (im angloamerikanischen Sprachraum „extended criteria donor“) ist bisher nicht eindeutig definiert. Die häufigsten Marginalitätskriterien sind hohes Spenderalter, Verfettung der Spenderleber und langer intensivstationärer Aufenthalt des Spenders. Der Einfluss der Verwendung marginaler Organe auf die Ergebnisse nach Lebertransplantation kann noch nicht abschließend beurteilt werden. Einer möglicherweise höheren Rate an Transplantatversagen und schlechterem Transplantat- und Empfängerüberleben durch die Nutzung marginaler Organe steht eine nachweisliche Senkung der Sterblichkeit auf der Warteliste gegenüber. Darüber hinaus muss die Bedeutung besonderer Risikokonstellationen wie ein hoher MELD-Score („model for endstage liver disease“) oder eine Hepatitis-C-assoziierte Lebererkrankung des Empfängers weiter untersucht werden. Due to the great shortage of donor organs in liver transplantation, the utilization of liver allografts from extended-criteria donors is gaining importance. An accepted precise definition of extended-criteria donors remains elusive. The most frequent criteria include high donor age, graft steatosis, and prolonged ICU stay. The influence of using extended-criteria donors on post-transplant outcome has yet to be defined. Its possibly higher rates of graft dysfunction and impaired graft and recipient survival are countered by a proven reduction in waiting-list mortality. Moreover, recipient factors of particular risk such as high MELD (model for endstage liver disease) score and underlying hepatitis C infection have to be defined and taken into consideration.
    Der Chirurg 02/2008; 79(2):130-134. · 0.52 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Along with the increasing need for living-donor liver transplantation (LDLT), the issue of organ shortage has become a serious problem. Therefore, the use of organs from elderly donors has been increasing. While the short-term results of LDLT have greatly improved, problems affecting the long-term outcome of transplant patients remain unsolved. Furthermore, since contradictory data have been reported with regard to the relationship between donor age and LT/LDLT outcome, the question of whether the use of elderly donors influences the long-term outcome of a graft after LT/LDLT remains unsettled. To address whether hepatocyte telomere length reflects the outcome of LDLT, we analyzed the telomere lengths of hepatocytes in informative biopsy samples from 12 paired donors and recipients (grafts) of pediatric LDLT more than 5 years after adult-to-child LDLT because of primary biliary atresia, using quantitative fluorescence in situ hybridization (Q-FISH). The telomere lengths in the paired samples showed a robust relationship between the donor and grafted hepatocytes (r = 0.765, p = 0.0038), demonstrating the feasibility of our Q-FISH method for cell-specific evaluation. While 8 pairs showed no significant difference between the telomere lengths for the donor and the recipient, the other 4 pairs showed significantly shorter telomeres in the recipient than in the donor. Multiple regression analysis revealed that the donors in the latter group were older than those in the former (p = 0.001). Despite the small number of subjects, this pilot study indicates that donor age is a crucial factor affecting telomere length sustainability in hepatocytes after pediatric LDLT, and that the telomeres in grafted livers may be elongated somewhat longer when the grafts are immunologically well controlled.
    PLoS ONE 04/2014; 9(4):e93749. · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As a consequence of the increase in life expectancy, hepatobiliary surgeons have to deal with an emerging aged population. We aimed to analyze the liver function and outcome after right hepatectomy (RH) in patients over 70 years of age. From January 2006 to December 2009, we prospectively collected data of 207 consecutive elective hepatectomies. In patients who had RH, cardiac risk was assessed by a dedicated preoperative workup. Liver failure (LF) was defined by the "fifty-fifty" criteria at postoperative day 5 (POD) and morbidity by the Clavien-Dindo classification. Liver function tests (LFTs) and short-term outcome were retrospectively analyzed in patients over (elderly group, EG) and younger (young group, YG) than 70 years of age. Eighty-seven consecutive RH were performed during the study period. Indication for surgery included 90 % malignancy in 47 % of patients requiring preoperative chemotherapy. ASA grade > 2 (44 vs. 16 %, p = 0.027), ischemic heart disease (17 vs. 5 %, p = 0.076), and preoperative cardiac failure (26 vs. 2 %, p < 0.001) were more frequent in the EG (n = 23) than in the YG (n = 64). Both groups were similar regarding rates of normal liver parenchyma, chemotherapy and intraoperative parameters. The overall morbidity rates were comparable, but the serious complication (grades III-V) rate was relatively higher in the EG (39 vs. 25 %, p = 0.199), particularly in patients with diabetes mellitus (100 vs. 29 %, p = 0.04) and those who had additional nonhepatic surgery (67 vs. 35 %, p = 0.110) and transfusions (44 vs. 30 %, p = 0.523). The 90-day mortality rate was similar (9 % in the EG vs. 3 % in the YG, p = 0.28) and was related to heart failure in the EG. LFTs showed a similar trend from POD 1 to 8, and patients ≥70 years of age had no liver failure. Age ≥70 years alone is not a contraindication to RH. However, major morbidity is particularly higher in the elderly with diabetes. This high-risk group should be closely monitored in the postoperative course. Liver function is not altered in the elderly patient after RH.
    World Journal of Surgery 05/2012; 36(9):2161-70. · 2.35 Impact Factor