Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2018; 24(47): 5391-5402
Published online Dec 21, 2018. doi: 10.3748/wjg.v24.i47.5391
Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over
Oscar Caso-Maestro, Carlos Jiménez-Romero, Iago Justo-Alonso, Jorge Calvo-Pulido, David Lora-Pablos, Alberto Marcacuzco-Quinto, Félix Cambra-Molero, Alvaro García-Sesma, Marina Pérez-Flecha, Carlos Muñoz-Arce, Carmelo Loinaz-Segurola, Alejandro Manrique-Municio
Oscar Caso-Maestro, Carlos Jiménez-Romero, Iago Justo-Alonso, Jorge Calvo-Pulido, Alberto Marcacuzco-Quinto, Félix Cambra-Molero, Alvaro García-Sesma, Marina Pérez-Flecha, Carlos Muñoz-Arce, Carmelo Loinaz-Segurola, Alejandro Manrique-Municio, Unit of HBP Surgery and Abdominal Organs Transplantation, Department of General Surgery, “12 de octubre” University Hospital, Madrid 28041, Spain
David Lora-Pablos, Clinical Research Department, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), “12 de octubre” University Hospital, Madrid 28041, Spain
Author contributions: Caso-Maestro O designed research, analyzed data and wrote the paper; Jiménez-Romero C designed the research and analyzed data; Justo-Alonso I participated collected and analyzed data; Calvo-Pulido J, Marcacuzco-Quinto A, Cambra-Molero F, García-Sesma A, Pérez-Flecha M, Muñoz-Arce C and Loinaz-Segurola C collected data; Lora-Pablos D performed the research and contributed new reagents or analytic tools; Manrique-Municio A participated collected and analyzed data.
Institutional review board statement: This study was approved by the institutional review board of “12 de octubre” University Hospital.
Informed consent statement: Patients were not required to give the informed consent to the study because the analysis used the anonymous data that were collected after each patient agreed to treatment.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
Data sharing statement: No additional data is available.
STROBE statement: The authors have read the STROBE checklist and have checked the manuscript accordingly.
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/
Corresponding author to: 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
Telephone: +34-91-3908294
Received: October 5, 2018
Peer-review started: October 5, 2018
First decision: November 7, 2018
Revised: November 24, 2018
Accepted: November 30, 2018
Article in press: November 30, 2018
Published online: December 21, 2018
Processing time: 78 Days and 16.4 Hours
Abstract
AIM

To increase the number of available grafts.

METHODS

This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation (LT) were performed with donors ≥ 70 years old (study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old (control group).

RESULTS

Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus (HCV)-positivity [hazard ratio (HR) = 2.35; 95% confidence interval (CI): 1.55-3.56; P = 0.00]; recipient age (HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease (D-MELD) (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium (HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD (donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients (77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00).

CONCLUSION

A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.

Keywords: Liver transplantation; Aged donors; Old donors; Marginal donors; Donor age

Core tip: The use of aged grafts is one of the main strategies to increase the number of available grafts. After analyzing the results of liver transplantation performed with donors ≥ 70 years old, we identified as independent predictors of graft survival: donor age X model for end-stage liver disease (D-MELD), recipient age and hepatitis C virus (HCV) infection. After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD (donor age X recipient age X MELD), which seems to be a good measure to predict graft survival when using grafts ≥ 70 years old, regardless of the HCV infection.