TY - JOUR
T1 - Liver transplantations with donors aged 60 years and above
T2 - The low liver damage strategy
AU - Ravaioli, Matteo
AU - Grazi, Gian Luca
AU - Cescon, Matteo
AU - Cucchetti, Alessandro
AU - Ercolani, Giorgio
AU - Fiorentino, Michelangelo
AU - Panzini, Ilaria
AU - Vivarelli, Marco
AU - Ramacciato, Giovanni
AU - Del Gaudio, Massimo
AU - Vetrone, Gaetano
AU - Zanello, Matteo
AU - Dazzi, Alessandro
AU - Zanfi, Chiara
AU - Di Gioia, Paolo
AU - Bertuzzo, Valentina
AU - Lauro, Augusto
AU - Morelli, Cristina
AU - Pinna, Antonio Daniele
PY - 2009/4
Y1 - 2009/4
N2 - 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.
AB - 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.
KW - Donor age
KW - Extended criteria donors
KW - Graft survival
KW - Ischemia time
KW - Liver biopsy
KW - Liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=61849097231&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=61849097231&partnerID=8YFLogxK
U2 - 10.1111/j.1432-2277.2008.00812.x
DO - 10.1111/j.1432-2277.2008.00812.x
M3 - Article
C2 - 19040483
AN - SCOPUS:61849097231
VL - 22
SP - 423
EP - 433
JO - Transplant International
JF - Transplant International
SN - 0934-0874
IS - 4
ER -