Liver transplantations with donors aged 60 years and above: The low liver damage strategy

Matteo Ravaioli, Gian Luca Grazi, Matteo Cescon, Alessandro Cucchetti, Giorgio Ercolani, Michelangelo Fiorentino, Ilaria Panzini, Marco Vivarelli, Giovanni Ramacciato, Massimo Del Gaudio, Gaetano Vetrone, Matteo Zanello, Alessandro Dazzi, Chiara Zanfi, Paolo Di Gioia, Valentina Bertuzzo, Augusto Lauro, Cristina Morelli, Antonio Daniele Pinna

Research output: Contribution to journalArticlepeer-review

Abstract

According to transplant registries, grafts from elderly donors have lower survival rates. During 1999-2005, we evaluated the outcomes of 89 patients who received a liver from a donor aged ≥ 60 years and managed with the low liver-damage strategy (LLDS), based on the preoperative donor liver biopsy and the shortest possible ischemia time (group D ≥ 60-LLDS). Group D ≥ 60-LLDS was compared with 198 matched recipients, whose grafts were not managed with this strategy (89 donors <60 years, group D <60-no-LLDS and 89 donors aged ≥60 years, group D ≥ 60-no-LLDS). In the donors proposed from the age group of ≥60 years, the number of donors rejected decreased during the study period and the LLDS was found to be responsible for this in a significant manner (47% vs. 60%, respectively P <0.01). Among the recipients transplanted, the clinical features (age, gender, viral infection, child and model for end-stage liver disease score) were comparable among groups, but group D ≥ 60-LLDS had a lower mean ischemia time: 415 ± 106 min vs. 465 ± 111 (D <60-no-LLDS), P <0.05 and vs. 476 ± 94 (D ≥ 60-no-LLDS), P <0.05. After a median follow-up of 3 years, the 1- and 3-year graft survival rates of group D ≥ 60-LLDS (84% and 76%) were comparable with group D <60-no-LLDS (89% and 76%) and were significantly higher than group D ≥ 60-no-LLDS (71% and 54%), P <0.005. In conclusion, the LLDS optimized the use of livers from elderly donors.

Original languageEnglish
Pages (from-to)423-433
Number of pages11
JournalTransplant International
Volume22
Issue number4
DOIs
Publication statusPublished - Apr 2009

Keywords

  • Donor age
  • Extended criteria donors
  • Graft survival
  • Ischemia time
  • Liver biopsy
  • Liver transplantation

ASJC Scopus subject areas

  • Transplantation

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