TY - JOUR
T1 - Long-term survival of recipients of liver grafts from donors older than 80 years
T2 - Is it achievable?
AU - Cescon, Matteo
AU - Grazi, Gian Luca
AU - Ercolani, Giorgio
AU - Nardo, Bruno
AU - Ravaioli, Matteo
AU - Gardini, Andrea
AU - Cavallari, Antonino
PY - 2003/11
Y1 - 2003/11
N2 - Isolated cases or small series of orthotopic liver transplantation (OLT) with grafts from donors older than 80 years have been reported, but the long-term outcome of patients receiving livers from extremely old donors is unknown. From 1998 to 2003, we performed 17 OLTs with donors older than 80 years (median, 82 years; range, 80 to 87 years). No deaths occurred in the early postoperative period. We analyzed the outcome in 12 patients with a follow-up longer than 1 year. Hepatic insufficiency was caused by hepatitis C virus (HCV)-related cirrhosis in five cases (42%) and non-HCV-related diseases in seven cases (58%). All donors had normal liver function, hemodynamic stability, and no parenchymal alterations. OLT was uneventful in all cases. Median follow-up was 30.3 months (range, 17 to 42 months). No late vascular complications occurred. One patient (8.3%) died 3 years after OLT for causes unrelated to hepatic dysfunction. Two- and 3-year actuarial survival rates were 100% and 75%, respectively. All HCV-positive (HCV+) patients developed hepatitis recurrence (after 2, 3, 4, 5, and 22 months) requiring antiviral treatment in 3 patients and leading to graft cirrhosis in 1 patient. Non-HCV+ patients had well-preserved liver function throughout the observation period. At the end of follow-up, we observed no clinical hepatic decompensation in the entire group and biochemical signs of recurrent disease in 3 patients. Use of grafts for OLT from donors older than 80 years is safe because of their potentially normal functional recovery. A selection among available organs is mandatory to minimize other risk factors for poor outcome. Long-term patient and graft survival seem to be achievable, but the high rate and rapidity of HCV reinfection remain a major concern for HCV+ patients.
AB - Isolated cases or small series of orthotopic liver transplantation (OLT) with grafts from donors older than 80 years have been reported, but the long-term outcome of patients receiving livers from extremely old donors is unknown. From 1998 to 2003, we performed 17 OLTs with donors older than 80 years (median, 82 years; range, 80 to 87 years). No deaths occurred in the early postoperative period. We analyzed the outcome in 12 patients with a follow-up longer than 1 year. Hepatic insufficiency was caused by hepatitis C virus (HCV)-related cirrhosis in five cases (42%) and non-HCV-related diseases in seven cases (58%). All donors had normal liver function, hemodynamic stability, and no parenchymal alterations. OLT was uneventful in all cases. Median follow-up was 30.3 months (range, 17 to 42 months). No late vascular complications occurred. One patient (8.3%) died 3 years after OLT for causes unrelated to hepatic dysfunction. Two- and 3-year actuarial survival rates were 100% and 75%, respectively. All HCV-positive (HCV+) patients developed hepatitis recurrence (after 2, 3, 4, 5, and 22 months) requiring antiviral treatment in 3 patients and leading to graft cirrhosis in 1 patient. Non-HCV+ patients had well-preserved liver function throughout the observation period. At the end of follow-up, we observed no clinical hepatic decompensation in the entire group and biochemical signs of recurrent disease in 3 patients. Use of grafts for OLT from donors older than 80 years is safe because of their potentially normal functional recovery. A selection among available organs is mandatory to minimize other risk factors for poor outcome. Long-term patient and graft survival seem to be achievable, but the high rate and rapidity of HCV reinfection remain a major concern for HCV+ patients.
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U2 - 10.1053/jlts.2003.50234
DO - 10.1053/jlts.2003.50234
M3 - Article
C2 - 14586878
AN - SCOPUS:0242624555
VL - 9
SP - 1174
EP - 1180
JO - Liver Transplantation
JF - Liver Transplantation
SN - 1527-6465
IS - 11
ER -