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Improving the outcome of liver transplantation with very old donors with updated selection and management criteria
Author(s) -
Cescon Matteo,
Grazi Gian Luca,
Cucchetti Alessandro,
Ravaioli Matteo,
Ercolani Giorgio,
Vivarelli Marco,
D'Errico Antonietta,
Del Gaudio Massimo,
Pinna Antonio Daniele
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21433
Subject(s) - medicine , liver transplantation , gastroenterology , liver biopsy , liver disease , surgery , transplantation , stage (stratigraphy) , biopsy , paleontology , biology
Advanced donor age is a risk factor for poor outcome in liver transplantation (LT). We reviewed 553 consecutive transplants according to donor age categories [group 1 (n = 173): <50 years; group 2 (n = 96): 50–59 years; group 3 (n = 132): 60–69 years; group 4 (n = 111): 70–79 years; group 5 (n = 41): ≥80 years]. Clinical parameters were comparable between groups. Group 5 had the highest proportion of pretransplant liver biopsy (85%), with only 1 graft showing macrovesicular steatosis > 30%, and the lowest ischemia time. Five‐year graft survival was significantly higher in group 1 (75%) versus groups 3 (60%) and 4 (62%; P = 0.01 and P = 0.001, respectively) and in group 5 (81%) versus groups 3 and 4 ( P = 0.04 and P = 0.01, respectively). Donor age of 60–79 years, recipient hepatitis C virus–positive status, Model for End‐Stage Liver Disease score ≥ 25, and emergency LT were predictors of poor survival. In hepatitis C virus–positive patients, 5‐year graft survival was 72% in group 1, 85% in group 2, 52% in group 3, 65% in group 4, and 71% in group 5 (group 1 versus group 3, P = 0.04; group 2 versus group 3, P = 0.03). In conclusion, older donor grafts managed with routine graft biopsy and short ischemia time may work effectively, regardless of the severity of the recipient's liver disease. Liver Transpl, 2008. © 2008 AASLD.