Optimizing the Use of Geriatric Livers for Transplantation in the Eurotransplant Region.

Autor: de Boer JD; Departments of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, the Netherlands.; Eurotransplant International Foundation, Leiden, the Netherlands., Blok JJ; Departments of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, the Netherlands., Putter H; Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands., Koopman JJE; Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands., van Hoek B; Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands., Samuel U; Eurotransplant International Foundation, Leiden, the Netherlands., van Rosmalen M; Eurotransplant International Foundation, Leiden, the Netherlands., Metselaar HJ; Department of Hepatology, Division of Transplantation, Erasmus Medical Center, Rotterdam University, Rotterdam, the Netherlands., Alwayn IPJ; Departments of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, the Netherlands., Guba M; Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University of Munich Hospital, Munich, Germany., Braat AE; Departments of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, the Netherlands.
Jazyk: angličtina
Zdroj: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2019 Feb; Vol. 25 (2), pp. 260-274.
DOI: 10.1002/lt.25353
Abstrakt: Acceptance criteria for liver allografts are ever more expanding because of a persisting wait-list mortality. Older livers are therefore offered and used more frequently for transplantation. This study aims to analyze the use and longterm outcome of these transplantations. Data were included on 17,811 first liver transplantations (LTs) and information on livers that were reported for allocation but not transplanted from 2000 to 2015 in the Eurotransplant (ET) region. Graft survival was defined as the period between transplantation and date of retransplantation or date of recipient death. In the study period, 2394 (13%) transplantations were performed with livers ≥70 years old. Graft survival was 74%, 57%, and 41% at 1-, 5-, and 10-year follow-up, respectively. A history of diabetes mellitus in the donor (hazard ratio [HR], 1.3; P = 0.01) and positive hepatitis C virus antibody in the recipient (HR, 1.5; P < 0.001) are specific risk factors for transplantations with livers ≥70 years old. Although donor age is associated with a linearly increasing risk of graft loss between 25 and 80 years old, no difference in graft survival could be observed when "preferred" recipients were transplanted with a liver <70 or ≥70 years old (HR 1.1; CI 0.92-1.23, P = 0.40) or with a donor <40 or ≥70 years old (HR 1.2; CI 0.96-1.37, P = 0.13). Utilization of reported livers ≥70 years old increased from 42% in 2000-2003 to 76% in 2013-2015 without a decrease in graft survival (P = 0.45). In conclusion, an important proportion of LTs in the ET region are performed with livers ≥70 years old. The risk of donor age on graft loss increases linearly between 25 and 80 years old. Livers ≥70 years old can, however, be transplanted safely in preferred patients and are to be used more frequently to further reduce wait-list mortality.
(Copyright © 2018 The Authors. Liver Transplantation published by Wiley Periodicals, Inc. on behalf of American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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