Jiménez-Romero C, Cambra F, Caso O, Manrique A, Calvo J, Marcacuzco A, Rioja P, Lora D, Justo I. Octogenarian liver grafts: Is their use for transplant currently justified? World J Gastroenterol 2017; 23(17): 3099-3110 [PMID: 28533667 DOI: 10.3748/wjg.v23.i17.3099]
Corresponding Author of This Article
Carlos Jiménez-Romero, MD, PhD, FACS, Head of HPB Surgery and Abdominal Organ Transplantation Unit, University Hospital “Doce de Octubre”, 4ª Planta, Ctra Andalucía Km 5, 4, 28041 Madrid, Spain. carlos.jimenez@inforboe.es
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 7, 2017; 23(17): 3099-3110 Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3099
Table 1 Donor characteristics n (%)
Characteristics
Donors ≤ 65 yr
Donors ≥ 80 yr
P value
Group A (n = 102)
Group B (n = 51)
Donor age (yr)
46.9 ± 15.0
83.5 ± 2.8
< 0.001
Sex (male/female)
62/40
13/38
< 0.001
Body mass index
26.9 ± 4.5
27.2 ± 5.4
0.670
> 30
26 (25.7)
15 (29.4)
0.800
Cause of donor death
0.006
Cerebrovascular
64 (62.7)
39 (76.5)
Head trauma
24 (23.5)
12 (23.5)
Anoxia
11 (10.8)
0
Other causes
3 (3.0)
0
ICU stay (h)
67.6 ± 79.6
49.9 ± 47.6
0.007
Vasopressor use
78 (76.5)
33 (64.7)
0.120
Cardiac arrest
26 (25.5)
1 (2.0)
< 0.001
Total bilirubin (mg/dL)
0.77 ± 0.74
1.05 ± 1.25
0.049
GOT (IU/L)
63 ± 76
30 ± 19
< 0.001
GPT (IU/L)
55 ± 69
22 ± 18
< 0.001
GGT (IU/L)
54 ± 61
38 ± 44
0.058
Prothrombin rate (%)
80 ± 20
77 ± 23
0.460
Sodium (meq/L)
147 ± 10
143 ± 5
0.001
Type of steatosis
Microsteatosis
26 (25.5)
11 (21.5)
0.590
Macrosteatosis
53 (52.0)
19 (37.3)
0.086
Grade of macrosteatosis
Mild (< 30%)
45 (44.1)
19 (37.3)
0.290
Moderate (30%-60%)
6 (5.9)
0 (0)
0.077
Severe (> 60%)
2 (2.0)
0 (0)
Preservation injury
0.140
Mild
39 (30.4)
14 (27.5)
Moderate
30 (26.5)
13 (25.5)
Severe
6 (5.9)
3 (5.8)
CIT (min)
406 ± 181
476 ± 132
0.091
WIT (min)
65 ± 15
59 ± 12
0.170
Table 2 Recipient characteristics n (%)
Characteristics
Donors ≤ 65 years
Donors ≥ 80 years
P value
Group A (n = 102)
Group B (n = 51)
Mean recipient age (yr)
52.6 ± 11.5
58.0 ± 8.7
0.044
Sex (male/female)
71/31
42/9
0.091
BMI
27.3 ± 4.0
27.3 ± 4.7
0.400
Etiology
Alcoholic cirrhosis
47 (46.1)
29 (56.9)
0.200
Viral C cirrhosis
16 (15.7)
10 (19.6)
0.540
Viral B cirrhosis
9 (8.8)
5 (9.8)
0.840
Hepatocarcinoma
24 (23.5)
18 (36.0)
0.100
Other
29 (28.4)
9 (17.6)
0.140
Child-Pugh distribution:
0.310
Grade A
19 (18.7)
13 (25.5)
Grade B
40 (39.2)
24 (47.0)
Grade C
43 (42.1)
14 (27.5)
MELD score
14.9 ± 5.5
14.5 ± 6.5
0.570
D-MELD score
706 ± 400
1205 ± 526
0.220
UNOS status:
0.160
Home
91 (89.2)
50 (98.1)
Hospital
9 (8.8)
1 (1.9)
ICU
2 (2.0)
0 (0)
Antecedents:
Diabetes
16 (15.7)
13 (25.5)
0.140
High blood pressure
19 (18.6)
13 (25.5)
0.320
Cardiopathy
20 (19.6)
12 (23.5)
0.570
Renal disease
8 (7.8)
3 (5.9)
0.650
Pre-LT laboratory values
Hemoglobin (g/100 mL)
11.5 ± 2.120
11.8 ± 2.3
0.300
Leukocytes/mm3
5264 ± 2060
5249 ± 2757
0.330
Platelets/mm3
97376 ± 55284
95568 ± 51651
0.910
Total bilirubin (mg/dL)
4.5 ± 7.5
2.7 ± 3.9
0.130
GOT (IU/L)
70 ± 59
74 ± 89
0.220
GPT (IU/L)
45 ± 36
51 ± 71
0.100
GGT (IU/L)
129 ± 159
100 ± 123
0.220
Alkaline phosphatase (IU/L)
233 ± 240
169 ± 129
0.067
Prothrombin rate (%)
63 ± 19
67 ± 21
0.650
Serum albumin (g/L)
3.36 ± 0.63
3.38 ± 0.64
0.570
Serum creatinine (mg/dL)
0.97 ± 0.42
1.07 ± 0.58
0.660
Serum glucose (mg/dL)
115 ± 47
143 ± 80
< 0.001
Table 3 Intraoperative and post-liver transplantation characteristics n (%)
Characteristics
Donors ≤ 65 yr
Donors ≥ 80 yr
P value
Group A (n = 102)
Group B (n = 51)
Biliary reconstruction:
0.090
Chol-Chol-without T-tube
86 (84.3)
49 (96.1)
Chol-Chol-with T-tube
12 (11.8)
2 (3.9)
Hepatico-jejunostomy
4 (3.9)
0
Transfusion
PRBC (mL)
3600 ± 4000
3320 ± 3748
0.390
Plasma (mL)
2520 ± 1842
2288 ± 1706
0.960
Platelets (units)
2.8 ± 3.1
2.2 ± 3.0
0.510
ICU stay (d)
5.1 ± 5.1
7.3 ± 8.5
0.015
Hospital stay (d)
21.9 ± 17.6
24.3 ± 17.6
0.520
Immunosuppression:
0.490
Cyclosporine
15 (14.7)
4 (7.8)
Tacrolimus
71 (69.6)
37 (72.6)
Tacrolimus + MMF
16 (15.7)
10 (19.6)
Table 4 Comparison between the groups of liver function parameters
Parameters
Donors ≤ 65 yr
Donors ≥ 80 yr
P value
Group A (n = 102)
Group B (n = 51)
GOT (IU/L)
1st d
763 ± 842
799 ± 1175
0.830
3rd d
183 ± 213
262 ± 254
0.076
7th d
67 ± 95
78 ± 74
0.470
30th d
31 ± 27
38 ± 43
0.260
GPT (IU/L)
1st d
697 ± 682
595 ± 525
0.370
3rd d
537 ± 650
484 ± 422
0.620
7th d
232 ± 198
217 ± 180
0.650
30th d
73 ± 104
51 ± 60
0.170
GGT (IU/L)
1st d
70 ± 71
61 ± 54
0.430
3rd d
167 ± 149
132 ± 102
0.100
7th d
272 ± 202
237 ± 157
0.310
30th d
226 ± 319
182 ± 205
0.390
A.Phosphatase (IU/L)
1st d
101 ± 82
120 ± 137
0.300
3rd d
148 ± 102
141 ± 101
0.690
7th d
172 ± 102
162 ± 155
0.640
30th d
262 ± 515
201 ± 236
0.440
Albumin (g/L)
1st d
2.9 ± 0.5
2.8 ± 0.7
0.280
3rd d
3.0 ± 0.5
2.7 ± 0.4
0.009
7th d
2.9 ± 0.4
2.5 ± 0.4
< 0.001
30th d
3.7 ± 0.8
3.5 ± 0.9
0.550
Prothrombin rate (%)
1st d
64 ± 18
56 ± 17
0.009
3rd d
86 ± 18
74 ± 17
< 0.001
7th d
91 ± 16
81 ± 18
0.001
30th d
90 ± 16
85 ± 18
0.990
Total bilirubin (mg/dL)
1st d
3.2 ± 3.3
4.0 ± 3.0
0.140
3rd d
2.4 ± 2.6
3.0 ± 2.9
0.260
7th d
2.7 ± 3.6
3.1 ± 38
0.450
30th d
1.7 ± 4.3
1.9 ± 4.4
0.780
Table 5 Post-liver transplantation complications, retransplant rate and mortality n (%)
Complications and mortality
Donors ≤ 65 yr
Donors ≥ 80 yr
P value
Group A (n = 102)
Group B (n = 51)
Primary graft non-function
1 (0.98)
1 (1.96)
0.520
Acute rejection
33 (32.4)
10 (19.6)
0.110
Steroid-resistant rejection
6 (5.9)
1 (1.9)
0.200
Chronic rejection
2 (1.9)
1 (1.9)
0.980
Renal dysfunction
17 (16.7)
14 (27.5)
0.150
Renal filtration
1 (0.98)
4 (7.8)
Biliary
16 (15.7)
4 (7.8)
0.380
Vascular
4 (3.9)
0 (0)
0.350
Infections
24 (23.5)
12 (23.5)
0.940
Reoperations
8 (7.8)
4 (7.8)
0.970
HCV recurrence rate
64 (62.7)
34 (66.6)
0.530
Mean period (days from LT)
219 ± 119
251 ± 313
0.830
Retransplant cases
5 (4.9)
2 (3.9)
0.380
Primary non-function
1 (0.98)
1 (1.9)
Chronic rejection
1 (0.98)
0
Biliary complications
2 (1.96)
0
Hepatic artery thrombosis
1 (0.98)
0
HCV recurrence
0
1 (1.9)
Overall mortality
31 (30.4)
15 (29.4)
0.900
Causes of mortality
Cardiovascular
6 (5.9)
7 (13.7)
De novo tumors
8 (7.8)
1 (1.9)
Viral C recurrence
3 (2.9)
3 (5.9)
Infection
3 (2.9)
1 (1.9)
HCC recurrence
3 (2.9)
1 (1.9)
Chronic rejection
3 (2.9)
0 (0)
Primary non-function
1 (0.98)
0 (0)
Other
4 (3.9)
2 (3.9)
Table 6 Multivariate Cox regression analysis of predictors of patient and graft survival
Predictors of patient survival
HR
95%CI
P value
Donors ≤ 65 yr vs donors ≥ 80 yr
0.95
0.50-1.79
0.872
Cerebrovascular donor death
2.32
1.16-4.65
0.017
Hepatocarcinoma
2.28
1.21-4.29
0.011
Recipient preoperative bilirubin
1.05
1.02-1.09
0.004
Predictors of graft survival
Donors ≤ 65 yr vs donors ≥ 80 yr
0.84
0.43-1.62
0.596
Cerebrovascular donor death
2.22
1.08-4.58
0.030
Recipient preoperative bilirubin
1.04
1.01-1.08
0.008
Citation: Jiménez-Romero C, Cambra F, Caso O, Manrique A, Calvo J, Marcacuzco A, Rioja P, Lora D, Justo I. Octogenarian liver grafts: Is their use for transplant currently justified? World J Gastroenterol 2017; 23(17): 3099-3110