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Romano P, Cano L, Pietrasz D, Beghdadi N, Allard MA, Salloum C, Blandin F, Ciacio O, Pittau G, Adam R, Azoulay D, Sa Cunha A, Vibert E, De Carlis L, Vitale A, Cillo U, Cherqui D, Golse N. Liver Transplantation from Elderly Donors (≥85 Years Old). Cancers (Basel) 2024; 16:1803. [PMID: 38791881 PMCID: PMC11119999 DOI: 10.3390/cancers16101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Despite the ongoing trend of increasing donor ages in liver transplantation (LT) setting, a notable gap persists in the availability of comprehensive guidelines for the utilization of organs from elderly donors. This study aimed to evaluate the viability of livers grafts from donors aged ≥85 years and report the post-LT outcomes compared with those from "ideal" donors under 40 years old. METHODS Conducted retrospectively at a single center from 2005 to 2023, this study compared outcomes of LTs from donors aged ≥85 y/o and ≤40 y/o, with the propensity score matching to the recipient's gender, age, BMI, MELD score, redo-LT, LT indication, and cause of donor death. RESULTS A total of 76 patients received grafts from donors ≥85 y/o and were compared to 349 liver grafts from donors ≤40 y/o. Prior to PSM, the 5-year overall survival was 63% for the elderly group and 77% for the young group (p = 0.002). After PSM, the 5-year overall survival was 63% and 73% (p = 0.1). A nomogram, developed at the time of graft acceptance and including HCC features, predicted 10-year survival after LT using a graft from a donor aged ≥85. CONCLUSIONS In the context of organ scarcity, elderly donors emerge as a partial solution. Nonetheless, without proper selection, LT using very elderly donors yields inferior long-term outcomes compared to transplantation from very young donors ≤40 y/o. The resulting nomogram based on pre-transplant criteria allows for the optimization of elderly donor/recipient matching to achieve satisfactory long-term results, in addition to traditional matching methods.
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Affiliation(s)
- Pierluigi Romano
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
- Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), Second General Surgical Unit, University of Padova, 35122 Padua, Italy (U.C.)
- Department of General and Transplant Surgery, Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy;
| | - Luis Cano
- INRAE, CHU Pontchaillou, UMR 1241 NUMECAN, Université de Rennes, 35033 Rennes, France
| | - Daniel Pietrasz
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
- INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, 94805 Villejuif, France
| | - Nassiba Beghdadi
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
| | - Marc-Antoine Allard
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
- INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, 94805 Villejuif, France
| | - Chady Salloum
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
| | - Frédérique Blandin
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
| | - Oriana Ciacio
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
| | - Gabriella Pittau
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
| | - René Adam
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
| | - Daniel Azoulay
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
- INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, 94805 Villejuif, France
| | - Antonio Sa Cunha
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
- INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, 94805 Villejuif, France
| | - Eric Vibert
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
- INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, 94805 Villejuif, France
| | - Luciano De Carlis
- Department of General and Transplant Surgery, Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy;
| | - Alessandro Vitale
- Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), Second General Surgical Unit, University of Padova, 35122 Padua, Italy (U.C.)
| | - Umberto Cillo
- Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), Second General Surgical Unit, University of Padova, 35122 Padua, Italy (U.C.)
| | - Daniel Cherqui
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
- INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, 94805 Villejuif, France
| | - Nicolas Golse
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France; (P.R.); (N.B.); (O.C.); (G.P.); (R.A.)
- INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, 94805 Villejuif, France
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Xiang Z, Li J, Zeng H, Xiang X, Gao F, Wang K, Wei X, Zheng S, Xu X. Current Understanding of Marginal Grafts in Liver Transplantation. Aging Dis 2024:AD.2024.0214. [PMID: 38607739 DOI: 10.14336/ad.2024.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/14/2024] [Indexed: 04/14/2024] Open
Abstract
End-stage liver disease (ESLD), stemming from a spectrum of chronic liver pathologies including chronic liver failure, acute cirrhosis decompensation and hepatocellular carcinoma, imposes a significant global healthcare burden. Liver transplantation (LT) remains the only treatment for ESLD. However, the escalating mortality on transplant waitlists has prompted the utilization of marginal liver grafts in LT procedures. These grafts primarily encompass elderly livers, steatotic livers, livers from donation after circulatory death, split livers and those infected with the hepatitis virus. While the expansion of the donor pool offers promise, it also introduces concomitant risks. These encompass graft failure, biliary and cardiovascular complications, the recurrence of liver disease and reduced patient and graft survival. Consequently, various established strategies, ranging from improved donor-recipient matching to surgical interventions, have emerged to mitigate these risks. This article undertakes a comprehensive assessment of the current landscape, evaluating the viability of diverse marginal liver grafts. Additionally, it synthesizes approaches aimed at enhancing the quality of such marginal liver grafts. The overarching objective is to augment the donor pool and ameliorate the risk factors associated with the shortage of liver grafts.
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Affiliation(s)
- Ze Xiang
- Department of Hepatobiliary and Pancreatic Surgery, Hangzhou First People's Hospital, Hangzhou 310006, China
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jiarui Li
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Huixuan Zeng
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xiaonan Xiang
- Zhejiang University School of Medicine, Hangzhou 310058, China
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, Cambridgeshire, UK
| | - Fengqiang Gao
- Department of Hepatobiliary and Pancreatic Surgery, Hangzhou First People's Hospital, Hangzhou 310006, China
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Kai Wang
- Department of Hepatobiliary and Pancreatic Surgery, Hangzhou First People's Hospital, Hangzhou 310006, China
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xuyong Wei
- Department of Hepatobiliary and Pancreatic Surgery, Hangzhou First People's Hospital, Hangzhou 310006, China
| | - Shusen Zheng
- Zhejiang University School of Medicine, Hangzhou 310058, China
- Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
- NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China
| | - Xiao Xu
- Zhejiang University School of Medicine, Hangzhou 310058, China
- NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China
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Jimenez-Romero C, Justo-Alonso I, del Pozo-Elso P, Marcacuzco-Quinto A, Martín-Arriscado-Arroba C, Manrique-Municio A, Calvo-Pulido J, García-Sesma A, San Román R, Caso-Maestro O. Post-transplant biliary complications using liver grafts from deceased donors older than 70 years: Retrospective case-control study. World J Gastrointest Surg 2023; 15:1615-1628. [PMID: 37701699 PMCID: PMC10494601 DOI: 10.4240/wjgs.v15.i8.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/27/2023] [Accepted: 06/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors. AIM To determine the incidence, outcomes, and risk factors for biliary complications (BC) in liver transplantation (LT) using liver grafts from donors aged > 70 years. METHODS Between January 1994 and December 31, 2019, 297 LTs were performed using donors older than 70 years. After excluding 47 LT for several reasons, we divided 250 LTs into two groups, namely post-LT BC (n = 21) and without BC (n = 229). This retrospective case-control study compared both groups. RESULTS Choledocho-choledochostomy without T-tube was the most frequent technique (76.2% in the BC group vs 92.6% in the non-BC group). Twenty-one patients (8.4%) developed BC (13 anastomotic strictures, 7 biliary leakages, and 1 non-anastomotic biliary stricture). Nine patients underwent percutaneous balloon dilation and nine required a Roux-en-Y hepaticojejunostomy because of dilation failure. The incidence of post-LT complications (graft dysfunction, rejection, renal failure, and non-BC reoperations) was similar in both groups. There were no significant differences in the patient and graft survival between the groups. Moreover, only three deaths were attributed to BC. While female donors were protective factors for BC, donor cardiac arrest was a risk factor. CONCLUSION The incidence of BC was relatively low on using liver grafts > 70 years. It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy, without significant differences in the patient or graft survival between the groups.
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Affiliation(s)
- Carlos Jimenez-Romero
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Iago Justo-Alonso
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Pilar del Pozo-Elso
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Alberto Marcacuzco-Quinto
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | | | - Alejandro Manrique-Municio
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Jorge Calvo-Pulido
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Alvaro García-Sesma
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Ricardo San Román
- Department of Radiology, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Oscar Caso-Maestro
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
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Houben P, Bormann E, Kneifel F, Katou S, Morgül MH, Vogel T, Bahde R, Radünz S, Pascher A, Schmidt H, Brockmann JG, Becker F. How Old Is Old? An Age-Stratified Analysis of Elderly Liver Donors above 65. J Clin Med 2022; 11:jcm11133899. [PMID: 35807185 PMCID: PMC9267186 DOI: 10.3390/jcm11133899] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023] Open
Abstract
In liver transplantation, older donor age is a well-known risk factor for dismal outcomes, especially due to the high susceptibility of older grafts to ischemia-reperfusion injury. However, whether the factors correlating with impaired graft and patient survival following the transplantation of older grafts follow a linear trend among elderly donors remains elusive. In this study, liver transplantations between January 2006 and May 2018 were analyzed retrospectively. Ninety-two recipients of grafts from donors ≥65 years were identified and divided into two groups: (1) ≥65–69 and (2) ≥ 70 years. One-year patient survival was comparable between recipients of grafts from donors ≥65–69 and ≥70 years (78.9% and 70.0%). One-year graft survival was 73.1% (donor ≥65–69) and 62.5% (donor ≥ 70), while multivariate analysis revealed superior one-year graft survival to be associated with a donor age of ≥65–69. No statistically significant differences were found for rates of primary non-function. The influence of donor age on graft and patient survival appears not to have a distinct impact on dismal outcomes in the range of 65–70 years. The impact of old donor age needs to be balanced with other risk factors, as these donors provide grafts that offer a lifesaving graft function.
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Affiliation(s)
- Philipp Houben
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
- Correspondence: ; Tel.: +49-251-835-6301; Fax: +49-251-835-6311
| | - Eike Bormann
- Institute of Biostatistics and Clinical Research, University Hospital Münster, 48149 Münster, Germany;
| | - Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Mehmet Haluk Morgül
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Thomas Vogel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Ralf Bahde
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Sonia Radünz
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Hartmut Schmidt
- Department of Internal Medicine B, Gastroenterology and Hepatology, University Hospital Münster, 48149 Münster, Germany;
| | - Jens Gunther Brockmann
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
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Caso Maestro O, Justo Alonso I, Marcacuzco Quinto A, Manrique Municio A, Calvo Pulido J, García‐Sesma A, Jiménez‐Romero C. Expanding donor age in liver transplantation using liver grafts from nonagenarian donors. Clin Transplant 2022; 36:e14684. [DOI: 10.1111/ctr.14684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/18/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Oscar Caso Maestro
- Unit of HPB Surgery and Abdominal Organ Transplantation `Doce de Octubre´ Hospital. Instituto de Investigación (imas12) Department of Surgery Faculty of Medicine Complutense University Madrid Spain
| | - Iago Justo Alonso
- Unit of HPB Surgery and Abdominal Organ Transplantation `Doce de Octubre´ Hospital. Instituto de Investigación (imas12) Department of Surgery Faculty of Medicine Complutense University Madrid Spain
| | - Alberto Marcacuzco Quinto
- Unit of HPB Surgery and Abdominal Organ Transplantation `Doce de Octubre´ Hospital. Instituto de Investigación (imas12) Department of Surgery Faculty of Medicine Complutense University Madrid Spain
| | - Alejandro Manrique Municio
- Unit of HPB Surgery and Abdominal Organ Transplantation `Doce de Octubre´ Hospital. Instituto de Investigación (imas12) Department of Surgery Faculty of Medicine Complutense University Madrid Spain
| | - Jorge Calvo Pulido
- Unit of HPB Surgery and Abdominal Organ Transplantation `Doce de Octubre´ Hospital. Instituto de Investigación (imas12) Department of Surgery Faculty of Medicine Complutense University Madrid Spain
| | - Alvaro García‐Sesma
- Unit of HPB Surgery and Abdominal Organ Transplantation `Doce de Octubre´ Hospital. Instituto de Investigación (imas12) Department of Surgery Faculty of Medicine Complutense University Madrid Spain
| | - Carlos Jiménez‐Romero
- Unit of HPB Surgery and Abdominal Organ Transplantation `Doce de Octubre´ Hospital. Instituto de Investigación (imas12) Department of Surgery Faculty of Medicine Complutense University Madrid Spain
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Abstract
Severe allograft dysfunction, as opposed to the expected immediate function, following liver transplantation is a major complication, and the clinical manifestations of such that lead to either immediate retransplant or death are the catastrophic end of the spectrum. Primary nonfunction (PNF) has declined in incidence over the years, yet the impact on patient and healthcare teams, and the burden on the organ pool in case of the need for retransplant should not be underestimated. There is no universal test to define the diagnosis of PNF, and current criteria are based on various biochemical parameters surrogate of liver function; moreover, a disparity remains within different healthcare systems on selecting candidates eligible for urgent retransplantation. The impact on PNF from traditionally accepted risk factors has changed somewhat, mainly driven by the rising demand for organs, combined with the concerted approach by clinicians on the in-depth understanding of PNF, optimal graft recipient selection, mitigation of the clinical environment in which a marginal graft is reperfused, and postoperative management. Regardless of the mode, available data suggest machine perfusion strategies help reduce the incidence further but do not completely avert the risk of PNF. The mainstay of management relies on identifying severe allograft dysfunction at a very early stage and aggressive management, while excluding other identifiable causes that mimic severe organ dysfunction. This approach may help salvage some grafts by preventing total graft failure and also maintaining a patient in an optimal physiological state if retransplantation is considered the ultimate patient salvage strategy.
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Affiliation(s)
- Hermien Hartog
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Safe use of livers from deceased donors older than 70 years in recipients with HCV cirrhosis treated with direct-action antivirals. Retrospective cohort study. Int J Surg 2021; 91:105981. [PMID: 34098075 DOI: 10.1016/j.ijsu.2021.105981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/28/2021] [Accepted: 05/25/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION There is controversy regarding the use of older grafts for liver transplantation (LT) in HCV-infected patients, but the introduction of direct-acting antivirals (DAA) can radically change that debate. METHODS The aim of this retrospective cohort study was to evaluate outcomes of the use of liver grafts from donors older than 70 years in recipients with HCV infection who underwent pre- or post-LT treatment with DAA. We compared two groups of patients who underwent LT using livers >70 years; the groups were defined according to antiviral therapy: non-DAA therapy group (n = 62; LT between May 1996 and December 2013), and DAA therapy group (n = 31; LT between January 2014 and December 2019). RESULTS Thirty (96.8%) patients of DAA therapy and nine (14.5%) of non-DAA therapy (21 patients underwent complete therapy with interferon-ribavirin) achieved sustained viral response (SVR). One, 3-, and 5-year patient survival were 83.9%, 67.7%, and 56.5% in the non-DAA group vs 93.5%, 88.4%, and 88.4% in the DAA group (P = 0.04); the 1-, 3-, and 5-year graft survival were 77.4%, 62.9%, and 51.6% in the non-DAA group vs. 88.6%, 83.7%, and 83.7% in the DAA group (P = 0.03). Multivariate analysis demonstrated donor female sex and DAA therapy as protective factors of graft survival. CONCLUSIONS Pre- or post-LT therapy with DAA in HCV-infected patients has achieved an almost overall SVR. The use of liver grafts >70 years in these patients treated with DAA was associated with significantly higher 5-year patient and graft survival in DAA group compared to non-DAA group. Thus, the introduction of DAA therapy has allowed the safe use of livers >70 years in HCV-positive recipients.
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8
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Differential Influence of Donor Age Depending on the Indication for Liver Transplantation-A Collaborative Transplant Study Report. Transplantation 2020; 104:779-787. [PMID: 32224813 DOI: 10.1097/tp.0000000000002970] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite steadily increasing donor age, there are no general guidelines for the use of organs from elderly donors in liver transplantation. This study focuses on identifying the recipients who are less affected from an old-donor organ graft and conversely in whom a rather unfavorable outcome is expected because of high donor age. METHODS Forty-eight thousand two hundred sixty-one adult liver transplantations, performed between 2000 and 2017 and reported to the Collaborative Transplant Study, were analyzed. RESULTS The proportion of ≥65-year-old donors has risen to >33% in recent years. The donor age has an approximately linear influence on graft survival. On average, each year's rise in the donor age was associated with a 0.9% increase in the risk of graft loss (hazard ratio [HR], 1.009; P < 0.001). The impact of donor age was strong in patients with hepatitis C-related cirrhosis (HR, 1.013; P < 0.001), substantial in patients with alcoholic cirrhosis (HR, 1.007; P < 0.001) and rather weak in patients with hepatocellular carcinoma (HR, 1.003; P = 0.038). The increase in the risk of graft loss per year rise in donor age was 1.4% for 18 to 49 year olds, 1.0% for middle-aged, and only 0.4% for ≥60-year-old recipients (all P < 0.001). CONCLUSIONS Consequently, older recipients and especially patients with hepatocellular carcinoma seem to be less affected by an increased donor age, whereas the donor age is an important factor in all other patient groups.
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9
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Bacalini MG, Franceschi C, Gentilini D, Ravaioli F, Zhou X, Remondini D, Pirazzini C, Giuliani C, Marasco E, Gensous N, Di Blasio AM, Ellis E, Gramignoli R, Castellani G, Capri M, Strom S, Nardini C, Cescon M, Grazi GL, Garagnani P. Molecular Aging of Human Liver: An Epigenetic/Transcriptomic Signature. J Gerontol A Biol Sci Med Sci 2019; 74:1-8. [PMID: 29554203 DOI: 10.1093/gerona/gly048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Indexed: 12/12/2022] Open
Abstract
The feasibility of liver transplantation from old healthy donors suggests that this organ is able to preserve its functionality during aging. To explore the biological basis of this phenomenon, we characterized the epigenetic profile of liver biopsies collected from 45 healthy liver donors ranging from 13 to 90 years old using the Infinium HumanMethylation450 BeadChip. The analysis indicates that a large remodeling in DNA methylation patterns occurs, with 8,823 age-associated differentially methylated CpG probes. Notably, these age-associated changes tended to level off after the age of 60, as confirmed by Horvath's clock. Using stringent selection criteria, we further identified a DNA methylation signature of aging liver including 75 genomic regions. We demonstrated that this signature is specific for liver compared to other tissues and that it is able to detect biological age-acceleration effects associated with obesity. Finally, we combined DNA methylation measurements with available expression data. Although the intersection between the two omic characterizations was low, both approaches suggested a previously unappreciated role of epithelial-mesenchymal transition and Wnt-signaling pathways in the aging of human liver.
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Affiliation(s)
| | - Claudio Franceschi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy.,DIMES-Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, Bologna, Italy.,CIG, Interdepartmental Center 'L. Galvani', Alma Mater Studiorum, Bologna, Italy
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Francesco Ravaioli
- DIMES-Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, Bologna, Italy
| | - Xiaoyuan Zhou
- Group of Clinical Genomic Networks, Key Laboratory of Computational Biology, CAS-MPG Partner Institute for Computational Biology, Shanghai Institutes for Biological Sciences, PR China.,University of Chinese Academy of Sciences, Beijing, PR China.,Department of Neurology, University of San Francisco, California
| | - Daniel Remondini
- Department of Physics and Astronomy (DIFA) and INFN Sez. Bologna, Alma Mater Studiorum, Italy
| | | | - Cristina Giuliani
- Department of Biological Geological and Environmental Sciences, Laboratory of Molecular Anthropology and Centre for Genome Biology, University of Bologna, Italy
| | - Elena Marasco
- CIG, Interdepartmental Center 'L. Galvani', Alma Mater Studiorum, Bologna, Italy
| | - Noémie Gensous
- DIMES-Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, Bologna, Italy
| | | | - Ewa Ellis
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Roberto Gramignoli
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Gastone Castellani
- CIG, Interdepartmental Center 'L. Galvani', Alma Mater Studiorum, Bologna, Italy.,Department of Biological Geological and Environmental Sciences, Laboratory of Molecular Anthropology and Centre for Genome Biology, University of Bologna, Italy
| | - Miriam Capri
- DIMES-Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, Bologna, Italy.,CIG, Interdepartmental Center 'L. Galvani', Alma Mater Studiorum, Bologna, Italy
| | - Stephen Strom
- Department of Laboratory Medicine, Karolinska Institute and Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Christine Nardini
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,CNR IAC "Mauro Picone", Roma, Italy.,Personal Genomics S.r.l., Verona, Italy
| | - Matteo Cescon
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Paolo Garagnani
- DIMES-Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, Bologna, Italy.,CIG, Interdepartmental Center 'L. Galvani', Alma Mater Studiorum, Bologna, Italy.,Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Applied Biomedical Research Center, S. Orsola-Malpighi Polyclinic, Bologna, Italy.,Institute of Molecular Genetics (IGM)-CNR, Unit of Bologna, Italy.,Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopaedic Institute, Bologna, Italy
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10
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Schneider S, Díaz Jaime F, Mara K, Dierkhising R, Heimbach J, Watt KD, Berenguer M. Long‐term outcomes of the octogenarian donor liver recipient: The era of the new centurion. Clin Transplant 2019; 33:e13629. [DOI: 10.1111/ctr.13629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Sarah Schneider
- Division of Internal Medicine Mayo Clinic Rochester Minnesota
| | - Francia Díaz Jaime
- Hepatology and Liver Transplantation Unit La Fe University Hospital Valencia Spain
| | - Kristin Mara
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota
| | - Ross Dierkhising
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota
| | | | - Kymberly D. Watt
- Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit La Fe University Hospital Valencia Spain
- Instituto de Investigación Sanitaria La Fe Valencia Spain
- CIBERehd (Networked Biomedical Research Center in Hepatic and Digestive Disease) Madrid Spain
- Facultad de Medicina Universidad de Valencia Valencia Spain
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11
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Ruggenenti P, Silvestre C, Boschiero L, Rota G, Furian L, Perna A, Rossini G, Remuzzi G, Rigotti P. Long-term outcome of renal transplantation from octogenarian donors: A multicenter controlled study. Am J Transplant 2017; 17:3159-3171. [PMID: 28792681 DOI: 10.1111/ajt.14459] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/11/2017] [Accepted: 08/01/2017] [Indexed: 02/06/2023]
Abstract
To assess whether biopsy-guided selection of kidneys from very old brain-dead donors enables more successful transplantations, the authors of this multicenter, observational study compared graft survival between 37 recipients of 1 or 2 histologically evaluated kidneys from donors older than 80 years and 198 reference-recipients of non-histologically evaluated single grafts from donors aged 60 years and younger (transplantation period: 2006-2013 at 3 Italian centers). During a median (interquartile range) of 25 (13-42) months, 2 recipients (5.4%) and 10 reference-recipients (5.1%) required dialysis (crude and donor age- and sex-adjusted hazard ratio [95% confidence interval] 1.55 [0.34-7.12], P = .576 and 1.41 [0.10-19.54], P = .798, respectively). Shared frailty analyses confirmed similar outcomes in a 1:2 propensity score study comparing recipients with 74 reference-recipients matched by center, year, donor, and recipient sex and age. Serum creatinine was similar across groups during 84-month follow-up. Recipients had remarkably shorter waiting times than did reference-recipients and matched reference-recipients (7.5 [4.0-19.5] vs 36 [19-56] and 40 [24-56] months, respectively, P < .0001 for both comparisons). Mean (± SD) kidney donor risk index was 2.57 ± 0.32 in recipients vs 1.09 ± 0.24 and 1.14 ± 0.24 in reference-recipients and matched reference-recipients (P < .0001 for both comparisons). Adverse events were similar across groups. Biopsy-guided allocation of kidneys from octogenarian donors permits further expansion of the donor organ pool and faster access to a kidney transplant, without increasing the risk of premature graft failure.
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Affiliation(s)
- Piero Ruggenenti
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Bergamo, Italy.,Nephrology and Dialysis Unit, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplant Unit, University Hospital of Padua, Padua, Italy
| | - Luigino Boschiero
- Kidney Transplantation Unit, Department of Surgery, Azienda Ospedaliero-Universitaria (AOUI) di Verona, Verona, Italy
| | - Giovanni Rota
- Kidney Transplantation Center, Unit of Pediatric Surgery, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplant Unit, University Hospital of Padua, Padua, Italy
| | - Annalisa Perna
- Nephrology and Dialysis Unit, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Rossini
- Organ and Tissue Transplant Immunology Unit, Foundation IRCCS "Ca' Granda Ospedale Maggiore Policlinico", Milan, Italy
| | - Giuseppe Remuzzi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Bergamo, Italy.,Nephrology and Dialysis Unit, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplant Unit, University Hospital of Padua, Padua, Italy
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12
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Díaz Jaime F, Berenguer M. Pushing the donor limits: Deceased donor liver transplantation using organs from octogenarian donors. Liver Transpl 2017; 23:S22-S26. [PMID: 28779558 DOI: 10.1002/lt.24841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Francia Díaz Jaime
- Hepatology and Liver Transplantation Unit, Department of Gastroenterology, La Fe University Hospital, Valencia, Spain
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, Department of Gastroenterology, La Fe University Hospital, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Network Center for Biomedical Research in Hepatic and Digestive Diseases, Madrid, Spain.,Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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