Published online Dec 21, 2018. doi: 10.3748/wjg.v24.i47.5391
Peer-review started: October 5, 2018
First decision: November 7, 2018
Revised: November 24, 2018
Accepted: November 30, 2018
Article in press: November 30, 2018
Published online: December 21, 2018
The increased life expectancy of the general population makes that donor age should also increase to ensure the number of available donors. Concerns regarding the use of aged organs are the perception of greater susceptibility to ischemic damage resulting in higher risk of initial poor function or primary non-function. There are limited published data evaluating results of liver transplantation (LT) with these donors and only a few of them try to identify predictors of graft survival.
Some authors have suggested that if we identify which variables are able to predict survival, careful donor to recipient matching could avoid some complications after LT with aged donors and improve patient and graft survival.
The main objective of our study is to evaluate LT outcomes with donors ≥ 70 years old using a large single-center cohort, identify predictors of graft survival and compare our results with previously published.
We analyzed all LT performed at our department between April 1986 and May 2016 with donors ≥ 70 years old, then we compared the outcomes with those obtained using younger donors in the same period and finally a multivariate Cox proportional hazard model was applied to analyze the prognostic value for the risk of graft loss in all LT performed with aged donors.
The use of donors ≥ 70 years old is a safe strategy to expand the donor pool. Graft and patient survivals are similar to those obtained with the use of younger grafts without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 independent predictors of graft survival: donor serum sodium and serum glutamic-pyruvic transaminase, recipient age, hepatitis C virus (HCV) and donor age X model for end-stage liver disease (D-MELD). Finally, we formulated a score using the D-MELD in combination with the age of the recipient (we called it DR-MELD), and we analyzed its ability to predict graft survival in the study group according to the presence or absence of the HCV. A DR-MELD < 75000 was a good measure to predict graft survival when using grafts ≥ 70 years old regardless the presence of HCV.
The use of aged donors in LT is not associated with higher primary non-function or other complications if we perform a careful donor selection. The current study emphasizes on the importance of identifying predictors of graft survival before donor to recipient matching. With the arrival of direct-acting antivirals, the results of LT with aged donors in HCV patients have changed and donor age will not influence anymore LT results in HCV recipients. Donor age, recipient age, MELD, cold ischemia time and the presence of steatosis seems to be the best predictors of graft survival after analyze the outcomes of several studies.
The use of aged donors is a safe alternative to expand the donor pool in LT with brain death donors. Additional studies are needed to investigate if the donor age could also be increased with marginal donors such as non-heart beating, split or living donors.