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 [PMID: 30598583 DOI: 10.3748/wjg.v24.i47.5391]
Corresponding Author of This Article
Oscar Caso-Maestro, MD, PhD, Associate Professor, Staff Physician, Surgeon, Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Av. Córdoba s/n, Madrid 28041, Spain. oscar.casomaes@salud.madrid.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control 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. 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
Trauma
72 (34.0)
32 (15.1)
Cerebrovascular
108 (50.9)
172 (81.1)
0.06
Other
32 (15.1)
8 (3.8)
History of hypertension
55 (25.9)
122 (57.5)
0.00
History of diabetes
14 (6.6)
43 (20.3)
0.00
ICU stay (h)
48 (24-96)
211 (24-48)
0.00
Cardiac arrest
53 (25.0)
14 (6.6)
0.00
Hemodynamic instability
68 (32.1)
60 (28.3)
0.39
Vasopressor use
173 (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
Normal
125 (57.8)
107 (49.8)
Microsteatosis
26 (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
Alcoholic
61 (28.8)
95 (44.8)
HBV
13 (6.1)
24 (11.3)
0.00
HCV
105 (49.5)
72 (34.0)
Other
33 (15.6)
21 (9.9)
HCC
82 (38.7)
84 (39.3)
0.89
Child-Pugh
A
47 (22.1)
46 (21.7)
B
75 (35.4)
89 (42)
0.22
C
90 (42.5)
77 (36.3)
MELD
15 (8)
13 (5)
0.20
MELD-Na
16 (11)
14 (9)
0.12
D-MELD
629 (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
ICU
0
3 (1.4)
0.77
Hospital
17 (8)
12 (5.7)
Home
195 (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 steroids
33 (15.6)
30 (14.3)
0.71
Tacrolimus plus steroids
179 (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-function
6 (2.8)
7 (3.3)
0.24
Acute rejection
61 (28.8)
53 (25.1)
0.39
Infectious complications
56 (26.4)
41 (19.3)
0.08
Medical complications
90 (42.5)
93 (43.9)
0.76
Surgical complications
38 (17.9)
34 (16)
0.60
Vascular complications
11 (5.2)
14 (6.6)
0.80
Biliary complications
24 (11.3)
11 (5.2)
0.41
Reoperation
27 (12.7)
20 (9.4)
0.28
De novo tumors
24 (11.3)
22 (10.4)
0.57
HCV recurrence
73 (61.9)
42 (57.5)
0.55
Days
141 (58-535)
148 (51-316)
0.90
Hepatitis F3 or F4
18 (24.7)
21 (50)
0.00
Fibrosing cholestatic hepatitis
7 (9.6)
7 (16.7)
0.26
Re-transplantation
11 (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 value
HR (95%CI)
P value
Donor age
1.23 (0.90-1.68)
0.19
1.15 (0.73-1.81)
0.52
Female donor
1.08 (0.78-1.49)
0.63
Donor BMI
25-29
1.56 (1.05-2.31)
0.08
≥ 30
1.53 (0.95-2.47)
0.07
Cause of death
Cerebrovascular
1.091 (0.75-1.58)
0.65
Others
0.68 (0.34-1.36)
0.28
Donor history of hypertension
1.53 (1.10-2.12)
0.00
1.43 (0.97-2.12)
0.07
Donor history of diabetes
0.99 (0.62-1.58)
0.97
Donor ICU stay
1.00 (0.99-1.00)
0.37
Donor cardiac arrest
0.94 (0.59-1.52)
0.82
Donor last serum sodium level
0.97 (0.96-0.99)
0.01
0.96 (0.94-0.99)
0.00
Donor last serum GOT
1.00 (1.00-1.00)
0.13
Donor last serum GPT
1.00 (1.00-1.00)
0.02
1.00 (1.00-1.00)
0.00
Biopsy findings
Normal
1.00 (0.64-1.59)
0.96
Microsteatosis
1.22 (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 age
1.03 (1.01-1.05)
0.00
1.04 (1.02-1.06)
0.00
HCV+ recipient
1.82 (1.32-2.50)
0.00
2.35 (1.55-3.56)
0.00
HCC presence
1.24 (0.90-1.71)
0.18
MELD
1.03 (1.00-1.06)
0.05
D-MELD
1.00 (1.00-1.00)
0.00
1.00 (1.00-1.00)
0.00
Prothrombin activity
0.99 (0.98-1.00)
0.28
CIT
0.99 (0.99-1.00)
0.13
WIT
1.01 (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
Author
Country
n
Donor age
Donor diabetes
Donor GPT
Donor Na
Recipient age
Recipient BMI
UNOS
HCV positive
MELD
D-MELD
BAR
CIT
Period
Renal replacement
Segev, 2007
United States
1043
X
X
X
X
X
Cescon, 2008
Italy
152
X
X
X
X
Jimenez Romero, 2013
Spain
50
X
Cepeda Franco, 2016
Spain
423
X
Bertuzzo, 2017
Italy
278
X
X
X
X
Montenovo, 2017
United States
1749
X
X
X
Ghinolfi, 2017
Italy
515
X
X
X
X
Present study, 2018
Spain
212
X
X
X
X
X
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