Case Control Study
Copyright ©The Author(s) 2018.
World J Gastroenterol. Dec 21, 2018; 24(47): 5391-5402
Published online Dec 21, 2018. doi: 10.3748/wjg.v24.i47.5391
Table 1 Donor characteristics n (%)
Donors < 70 years old (n = 212)Donors ≥ 70 years old (n = 212)P value
Age (yr)47 (26)76 (7)0.00
Gender (male/female)139/73 (65.6/34.3)87/125 (41.0/59.0)0.00
BMI ≥ 30 (kg/m2)33 (15.6)57 (27.3)0.00
Cause of death
Trauma72 (34.0)32 (15.1)
Cerebrovascular108 (50.9)172 (81.1)0.06
Other32 (15.1)8 (3.8)
History of hypertension55 (25.9)122 (57.5)0.00
History of diabetes14 (6.6)43 (20.3)0.00
ICU stay (h)48 (24-96)211 (24-48)0.00
Cardiac arrest53 (25.0)14 (6.6)0.00
Hemodynamic instability68 (32.1)60 (28.3)0.39
Vasopressor use173 (81.6)159 (75.0)0.09
Glucose (mg/dL)145 (63)156 (69)0.00
Creatinine (mg/dL)0.9 (0.5)0.8 (0.3)0.24
Sodium (mEq/L)148 (12)145 (11)0.00
GOT (IU/L)39 (55)28 (19)0.00
GPT (IU/L)27 (53)20 (17)0.00
Biopsy findings
Normal125 (57.8)107 (49.8)
Microsteatosis26 (12.6)41 (19.5)
Mild macrosteatosis (< 30%)54 (26.1)56 (26.7)0.12
Moderate macrosteatosis (30%-60%)7 (3.5)7 (3.5)
Severe macrosteatosis (≥ 60%)0 (0.0)1 (0.5)
Table 2 Recipient characteristics n (%)
Donors < 70 years old (n = 212)Donors ≥ 70 years old (n = 212)P value
Age (yr)54 (14)59 (13)0.00
Gender (male/female)161/51 (75.9/24.1)167/45 (78.8/21.2)0.48
Cirrhosis
Alcoholic61 (28.8)95 (44.8)
HBV13 (6.1)24 (11.3)0.00
HCV105 (49.5)72 (34.0)
Other33 (15.6)21 (9.9)
HCC82 (38.7)84 (39.3)0.89
Child-Pugh
A47 (22.1)46 (21.7)
B75 (35.4)89 (42)0.22
C90 (42.5)77 (36.3)
MELD15 (8)13 (5)0.20
MELD-Na16 (11)14 (9)0.12
D-MELD629 (475)1051 (842)0.00
Glucose (mg/dL)107 (44)105 (48)0.70
Creatinine (mg/dL)0.9 (0.4)0.9 (0.3)0.07
Total bilirubin (mg/dL)2.7 (3.4)1.9 (2.4)0.10
GOT (IU/L)54 (67)58 (58)0.77
GPT (IU/L)40 (49)37 (43)0.60
Albumin (mg/dL)3.3 (0.9)3.4 (1.0)0.77
Prothrombin activity (%)62 ± 20 (11.8-120)65 ± 18 (5-119)0.07
Platelets (n)77900 (54925)82500 (60250)0.16
UNOS
ICU03 (1.4)0.77
Hospital17 (8)12 (5.7)
Home195 (92)197 (92.9)
Table 3 Perioperative characteristics and post-liver transplantation complications n (%)
Donors < 70 years old (n = 212)Donors ≥ 70 years old (n = 212)P value
CIT (min)386 ± 168 (100-1038)445 ± 158 (60-975)0.00
WIT (min)64 ± 17 (40-200)61 ± 13 (30-130)0.04
Transfusional requeriments
RBC (U)6 (3-10)5 (3-10)0.98
FFP (U)12 ± 9 (0-60)13 ± 9 (0-58)0.40
Platelets (U)3 ± 3 (0-37)3 ± 3 (0-16)0.53
Basal immunosuppressant drugs
Cyclosporine plus steroids33 (15.6)30 (14.3)0.71
Tacrolimus plus steroids179 (84.4)180 (85.7)
ICU stay (d)4 (2-5)4 (2-6)0.58
Hospital stay (d)18 ± 17 (0-105)16 ± 12 (0-83)0.34
Primary non-function6 (2.8)7 (3.3)0.24
Acute rejection61 (28.8)53 (25.1)0.39
Infectious complications56 (26.4)41 (19.3)0.08
Medical complications90 (42.5)93 (43.9)0.76
Surgical complications38 (17.9)34 (16)0.60
Vascular complications11 (5.2)14 (6.6)0.80
Biliary complications24 (11.3)11 (5.2)0.41
Reoperation27 (12.7)20 (9.4)0.28
De novo tumors24 (11.3)22 (10.4)0.57
HCV recurrence73 (61.9)42 (57.5)0.55
Days141 (58-535)148 (51-316)0.90
Hepatitis F3 or F418 (24.7)21 (50)0.00
Fibrosing cholestatic hepatitis7 (9.6)7 (16.7)0.26
Re-transplantation11 (5.2)12 (5.7)0.83
Table 4 Multivariate Cox-regression analysis for the risk of graft loss
Univariate analysis
Multivariate analysis
HR (95%CI)P valueHR (95%CI)P value
Donor age1.23 (0.90-1.68)0.191.15 (0.73-1.81)0.52
Female donor1.08 (0.78-1.49)0.63
Donor BMI
25-291.56 (1.05-2.31)0.08
≥ 301.53 (0.95-2.47)0.07
Cause of death
Cerebrovascular1.091 (0.75-1.58)0.65
Others0.68 (0.34-1.36)0.28
Donor history of hypertension1.53 (1.10-2.12)0.001.43 (0.97-2.12)0.07
Donor history of diabetes0.99 (0.62-1.58)0.97
Donor ICU stay1.00 (0.99-1.00)0.37
Donor cardiac arrest0.94 (0.59-1.52)0.82
Donor last serum sodium level0.97 (0.96-0.99)0.010.96 (0.94-0.99)0.00
Donor last serum GOT1.00 (1.00-1.00)0.13
Donor last serum GPT1.00 (1.00-1.00)0.021.00 (1.00-1.00)0.00
Biopsy findings
Normal1.00 (0.64-1.59)0.96
Microsteatosis1.22 (0.82-1.82)0.31
Mild macrosteatosis (< 30%)1.89 (0.93-3.82)0.07
Moderate macrosteatosis (30%-60%)0.93 (0.57-1.53)0.78
Recipient age1.03 (1.01-1.05)0.001.04 (1.02-1.06)0.00
HCV+ recipient1.82 (1.32-2.50)0.002.35 (1.55-3.56)0.00
HCC presence1.24 (0.90-1.71)0.18
MELD1.03 (1.00-1.06)0.05
D-MELD1.00 (1.00-1.00)0.001.00 (1.00-1.00)0.00
Prothrombin activity0.99 (0.98-1.00)0.28
CIT0.99 (0.99-1.00)0.13
WIT1.01 (0.99-1.02)0.38
Table 5 Studies comparing liver transplantation with donors ≥ 70 years old vs liver transplantation with younger donors that provide multivariate analysis identifying predictors of graft survival
AuthorCountrynDonor ageDonor diabetesDonor GPTDonor NaRecipient ageRecipient BMIUNOSHCV positiveMELDD-MELDBARCITPeriodRenal replacement
Segev, 2007United States1043XXXXX
Cescon, 2008Italy152XXXX
Jimenez Romero, 2013Spain50X
Cepeda Franco, 2016Spain423X
Bertuzzo, 2017Italy278XXXX
Montenovo, 2017United States1749XXX
Ghinolfi, 2017Italy515XXXX
Present study, 2018Spain212XXXXX

  • Citation: Caso-Maestro O, Jiménez-Romero C, Justo-Alonso I, Calvo-Pulido J, Lora-Pablos D, Marcacuzco-Quinto A, Cambra-Molero F, García-Sesma A, Pérez-Flecha M, Muñoz-Arce C, Loinaz-Segurola C, Manrique-Municio A. Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over. World J Gastroenterol 2018; 24(47): 5391-5402
  • URL: https://www.wjgnet.com/1007-9327/full/v24/i47/5391.htm
  • DOI: https://dx.doi.org/10.3748/wjg.v24.i47.5391