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No country for old livers? Examining and optimizing the utilization of elderly liver grafts.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2018 Mar; Vol. 18 (3), pp. 669-678. Date of Electronic Publication: 2017 Nov 08. - Publication Year :
- 2018
-
Abstract
- Of the 1.6 million patients >70 years of age who died of stroke since 2002, donor livers were retrieved from only 2402 (0.15% yield rate). Despite reports of successful liver transplantation (LT) with elderly grafts (EG), advanced donor age is considered a risk for poor outcomes. Centers for Medicare and Medicaid Services definitions of an "eligible death" for donation excludes patients >70 years of age, creating disincentives to donation. We investigated utilization and outcomes of recipients of donors >70 through analysis of a United Network for Organ Sharing Standard Transplant Analysis and Research-file of adult LTs from 2002 to 2014. Survival analysis was conducted using Kaplan-Meier curves, and Cox regression was used to identify factors influencing outcomes of EG recipients. Three thousand one hundred four livers from donors >70, ≈40% of which were used in 2 regions: 2 (520/3104) and 9 (666/3104). Unadjusted survival was significantly worse among recipients of EG compared to recipients of younger grafts (P < .0001). Eight independent negative predictors of survival in recipients of EG were identified on multivariable analysis. Survival of low-risk recipients who received EG was significantly better than survival of recipients of younger grafts (P = .04). Outcomes of recipients of EG can therefore be optimized to equal outcomes of younger grafts. Given the large number of stroke deaths in patients >70 years of age, the yield rate of EGs can be maximized and disincentives removed to help resolve the organ shortage crisis.<br /> (© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Subjects :
- Aged
Female
Follow-Up Studies
Graft Survival
Humans
Liver Diseases surgery
Male
Middle Aged
Survival Rate
Transplant Recipients
Treatment Outcome
United States
Clinical Decision-Making
Donor Selection standards
Liver Diseases mortality
Liver Transplantation mortality
Postoperative Complications
Tissue Donors supply & distribution
Tissue and Organ Procurement standards
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 18
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 28960723
- Full Text :
- https://doi.org/10.1111/ajt.14518