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Impact of donor age in liver transplantation from donation after circulatory death donors: A decade of experience at C leveland C linic
Author(s) -
Firl Daniel J.,
Hashimoto Koji,
O'Rourke Colin,
DiagoUso Teresa,
Fujiki Masato,
Aucejo Federico N.,
Quintini Cristiano,
Kelly Dympna M.,
Miller Charles M.,
Fung John J.,
Eghtesad Bijan
Publication year - 2015
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.24316
Subject(s) - medicine , donation , liver transplantation , transplantation , organ donation , surgery , intensive care medicine , circulatory system , general surgery , economics , economic growth
The use of liver grafts from donation after circulatory death (DCD) donors remains controversial, particularly with donors of advanced age. This retrospective study investigated the impact of donor age in DCD liver transplantation. We examined 92 recipients who received DCD grafts and 92 matched recipients who received donation after brain death (DBD) grafts at Cleveland Clinic from January 2005 to June 2014. DCD grafts met stringent criteria to minimize risk factors in both donors and recipients. The 1‐, 3‐, and 5‐year graft survival in DCD recipients was significantly inferior to that in DBD recipients (82%, 71%, 66% versus 92%, 87%, 85%, respectively; P = 0.03). Six DCD recipients (7%), but no DBD recipients, experienced ischemic‐type biliary stricture ( P = 0.01). However, the incidence of biliary stricture was not associated with donor age ( P = 0.57). Interestingly, recipients receiving DCD grafts from donors who were <45 years of age (n = 55) showed similar graft survival rates compared to those receiving DCD grafts from donors who were ≥45 years of age (n = 37; 80%, 69%, 66% versus 83%, 72%, 66%, respectively; P = 0.67). Cox proportional hazards modeling in all study populations (n = 184) revealed advanced donor age ( P = 0.05) and the use of a DCD graft ( P = 0.03) as unfavorable factors for graft survival. Logistic regression analysis showed that the risk of DBD graft failure increased with increasing age, but the risk of DCD graft failure did not increase with increasing age ( P = 0.13). In conclusion, these data suggest that stringent donor and recipient selection may ameliorate the negative impact of donor age in DCD liver transplantation. DCD grafts should not be discarded because of donor age, per se, and could help expand the donor pool for liver transplantation. Liver Transpl 21:1494‐1503, 2015 . © 2015 AASLD.