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Survival Outcomes in Liver Transplantation With Elderly Donors: Analysis of Andalusian Transplant Register
- Source :
- Transplantation Proceedings. 48:2983-2986
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Recently, there has been a large discrepancy between the number of patients on the waiting list for a liver transplant and the availability of deceased donors, with an increase in annual wait list mortality rates. Elderly donor livers are thought to be marginal grafts; however, in recent years, their utilization has constantly increased. The aim of this study is to evaluate the utilization of elderly donors in Andalusia and post-transplant outcomes. This retrospective observational study of 2408 liver transplants, performed in Andalusia between 2000 and 2014, analyzes the outcomes from donors aged 70 plus (n = 423) in terms of survival rates of the graft and the recipient, the type of transplant, donor age, and D-MELD score (product of donor age and preoperative Model for End-stage Liver Disease score). The most frequent indications for transplant were alcoholic cirrhosis (49.2%), hepatitis C cirrhosis (13%), and hepatocellular carcinoma (12.5%). The overall survival at 5 years was 64%, with a significant fall in survival for recipients with a D-MELD greater than 1500 (57%; P = .045). In the 70-year-old-plus donor group, the overall patient survival was 58.4%. The retransplant rate increased proportionately with donor age. In the alcoholic cirrhosis recipient subgroup, the overall survival at 5 years was 67.6% (P < .05) compared with 33.5% in patients with hepatitis C. Use of elderly donors is a safe strategy to reduce the scarcity of donors, provided that a D-MELD score below 1500 is obtained. Retransplant rates increase progressively with donor age. It is necessary to carefully screen recipients of older organs, taking into account that the best results are obtained for alcoholic cirrhosis, negative viral load hepatitis C, and a D-MELD score below 1500.
- Subjects :
- Adult
Male
medicine.medical_specialty
Alcoholic liver disease
Carcinoma, Hepatocellular
Cirrhosis
Waiting Lists
medicine.medical_treatment
030230 surgery
Liver transplantation
End Stage Liver Disease
03 medical and health sciences
Liver disease
0302 clinical medicine
Liver Cirrhosis, Alcoholic
Internal medicine
Humans
Medicine
Registries
Survival rate
Aged
Retrospective Studies
Aged, 80 and over
Hepatitis
Transplantation
business.industry
Mortality rate
Graft Survival
Liver Neoplasms
Age Factors
Hepatitis C
Middle Aged
medicine.disease
Survival Analysis
Tissue Donors
Liver Transplantation
Surgery
Survival Rate
Spain
Female
030211 gastroenterology & hepatology
business
Subjects
Details
- ISSN :
- 00411345
- Volume :
- 48
- Database :
- OpenAIRE
- Journal :
- Transplantation Proceedings
- Accession number :
- edsair.doi.dedup.....e25d2e84275719eb9aab5b8238b28abc