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ILTS 2012 Report – Select elderly liver donor grafts perform the same as usual grafts, study finds
by Thomas R. Collins – Liver transplants involving selected organs from elderly patients performed just as well as livers from usual donors, investigators with a French study said here at 18th International Congress of the International Liver Transplantation Society.
Graft survival and graft function levels were no different between the two groups in the single-centre, extended-period study, prompting the research team to suggest that grafts from selected older patients should be regarded the same as those from traditional donors, said Takeshi Aoyagi, the researcher who presented the study for the group in the Hepatobiliary Surgery and Transplantation department at Beaujon Hospital in Clichy, France.
Using grafts from elderly donors is an alluring strategy to combat the shortage of livers available for transplantation. But the grafts have been seen as riskier because of the potential for primary non-function or early dysfunction, the possibility of the transmission of occult tumors, a hepatic artery thrombosis risk and poorer short- and long-term outcomes in HCV-positive recipients.
But some encouraging results have come out of recent studies, making elderly donors potentially a more attractive option.1,2
In the French study, investigators adhered to rules for contraindication. Grafts were not accepted from elderly donors if they had a history of a long cardiac arrest time (30 minutes or longer); elevated steatosis levels were found on ultrasound or CT scan; there were abnormal levels of gamma-glutamyl transferase, which can be a sign of liver damage; there were multiple associated co-morbidities; or if an abnormal gross appearance or steatosis was found upon harvesting.
Donors 75 and older were considered elderly, while those 40 to 60 years old were considered usual donors.
From 2004 to 2012, 84 liver transplants were performed using qualifying grafts from elderly donors and 135 were done with livers from usual donors. Grafts from cardiac death donors, living donors and split graft procedures were not considered in the study.
The average age in the elderly group was 80; it was 51 in the other group. There was a significant difference in the number of each group that had experienced a “short cardiac arrest” incident of less than 30 minutes. There were 3 in the elderly group, 4 percent, and 37 in the usual group, 27 percent.
Leading to the transplantation, there were no significant differences among the two groups of recipients. They had comparable percentages of Hepatitis C patients (30 for the recipients of the elderly grafts and 31 percent for the recipients of the usual donor grafts) and comparable MELD scores (17.8 and 19.1).
Perioperatively, the elderly grafts were found to have less severe steatosis on biopsy — a difference that was statistically significant. Also significant was that the elderly grafts had shorter warm ischemia times and shorter total operation times, on average.
The results for the recipients were very similar for each group of donor. Nine of the transplants involving elderly grafts experienced early graft dysfunction (11 percent), compared to 21 (16 percent) in the usual donor group. That was not a statistically significant difference. There was also no statistical difference in post-operative death, biliary complications or arterial complications.
Three-year graft survival for the elderly donor group was 75.2 percent, compared to 71.2 percent — not a statistically significant difference.
Patient survival — 78.7 percent to 77.9 percent — also was not statistically significant.
The investigators said that consideration of carefully selected grafts from older donors “should become a routine.”
“This large, single-center study,” Aoyagi said, “confirms that selected advanced donor age (grafts) provide excellent short- and long-term outcomes.”
References:
- Cescon et al Transplantation 2011 Aug 27; 92(4): 439-45
- Faber et al Transplant Proc 2011 Dec; 43(10): 3789-95
