Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2017; 23(17): 3099-3110
Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3099
Octogenarian liver grafts: Is their use for transplant currently justified?
Carlos Jiménez-Romero, Felix Cambra, Oscar Caso, Alejandro Manrique, Jorge Calvo, Alejandro Marcacuzco, Paula Rioja, David Lora, Iago Justo
Carlos Jiménez-Romero, Felix Cambra, Oscar Caso, Alejandro Manrique, Jorge Calvo, Alejandro Marcacuzco, Paula Rioja, David Lora, Iago Justo, HPB Surgery and Abdominal Organ Transplantation Unit, University Hospital “Doce de Octubre”, 28041 Madrid, Spain
Carlos Jiménez-Romero, Felix Cambra, Oscar Caso, Alejandro Manrique, Jorge Calvo, Alejandro Marcacuzco, Paula Rioja, David Lora, Iago Justo, Department of Surgery, Facultad de Medicina, UCM, 28041 Madrid, Spain
Author contributions: Jiménez-Romero C, Justo I designed research; Cambra F performed research; Caso O, Manrique A, Calvo J, Marcacuzco A, Rioja P contributed new reagents or analytic tools; Lora D analyzed data; Jiménez-Romero C wrote the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: 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/
Correspondence to: 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
Telephone: +34-91-3908294 Fax: +34-91-519271
Received: November 4, 2016
Peer-review started: November 21, 2016
First decision: December 28, 2016
Revised: January 12, 2017
Accepted: March 20, 2017
Article in press: March 20, 2017
Published online: May 7, 2017
Processing time: 183 Days and 3.4 Hours
Abstract
AIM

To analyse the impact of octogenarian donors in liver transplantation.

METHODS

We present a retrospective single-center study, performed between November 1996 and March 2015, that comprises a sample of 153 liver transplants. Recipients were divided into two groups according to liver donor age: recipients of donors ≤ 65 years (group A; n = 102), and recipients of donors ≥ 80 years (group B; n = 51). A comparative analysis between the groups was performed. Quantitative variables were expressed as mean values and SD, and qualitative variables as percentages. Differences in properties between qualitative variables were assessed by χ2 test. Comparison of quantitative variables was made by t-test. Graft and patient survivals were estimated using the Kaplan-Meier method.

RESULTS

One, 3 and 5-year overall patient survival was 87.3%, 84% and 75.2%, respectively, in recipients of younger grafts vs 88.2%, 84.1% and 66.4%, respectively, in recipients of octogenarian grafts (P = 0.748). One, 3 and 5-year overall graft survival was 84.3%, 83.1% and 74.2%, respectively, in recipients of younger grafts vs 84.3%, 79.4% and 64.2%, respectively, in recipients of octogenarian grafts (P = 0.524). After excluding the patients with hepatitis C virus cirrhosis (16 in group A and 10 in group B), the 1, 3 and 5-year patient (P = 0.657) and graft (P = 0.419) survivals were practically the same in both groups. Multivariate Cox regression analysis demonstrated that overall patient survival was adversely affected by cerebrovascular donor death, hepatocarcinoma, and recipient preoperative bilirubin, and overall graft survival was adversely influenced by cerebrovascular donor death, and recipient preoperative bilirubin.

CONCLUSION

The standard criteria for utilization of octogenarian liver grafts are: normal gross appearance and consistency, normal or almost normal liver tests, hemodynamic stability with use of < 10 μg/kg per minute of vasopressors before procurement, intensive care unit stay < 3 d, CIT < 9 h, absence of atherosclerosis in the hepatic and gastroduodenal arteries, and no relevant histological alterations in the pre-transplant biopsy, such as fibrosis, hepatitis, cholestasis or macrosteatosis > 30%.

Keywords: Older liver, Donor age, Marginal liver, Liver transplant, Aging liver

Core tip: An important solution for increasing the donor pool is the use of octogenarian livers after careful selection. We present a comparative study between a group of 102 recipients of donors ≤ 65 years, and 51 recipients of donors ≥ 80 years. One, 3 and 5-year overall patient survival was 87.3%, 84% and 75.2%, respectively, in recipients of younger grafts vs 88.2%, 84.1% and 66.4%, respectively, in recipients of octogenarian grafts (P = 0.748). One, 3 and 5-year overall graft survival was 84.3%, 83.1% and 74.2%, respectively, in recipients of younger grafts vs 84.3%, 79.4% and 64.2%, respectively, in recipients of octogenarian grafts (P = 0.524). With good selection octogenarian livers can be safely used.