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De Simone P, Ghinolfi D, Palladino S, Catalano G, Martinelli C, Ducci J, Bronzoni J, Tincani G, Balzano E, Carrai P, Petruccelli S, Campani D, Crocetti L, Lazzeri C, Biancofiore G, Peris A. First-in-human liver transplantation from a centenarian deceased donor after brain death. Am J Transplant 2024; 24:304-307. [PMID: 37757913 DOI: 10.1016/j.ajt.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
Liver transplantation from elderly donors is expanding due to demand for liver grafts, aging of recipients and donors, and introduction of machine perfusion. We report on a liver transplant from a 100-year-old deceased donor after brain death. The liver was transplanted after the use of hypothermic machine perfusion to a 60-year-old recipient with advanced hepatocellular carcinoma undergoing neoadjuvant immunotherapy. Nine months after the transplant, the patient is alive with a functioning graft and no evidence of acute rejection or tumor recurrence.
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Affiliation(s)
- Paolo De Simone
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy; Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy.
| | - Davide Ghinolfi
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Simona Palladino
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Gabriele Catalano
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Caterina Martinelli
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Juri Ducci
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Jessica Bronzoni
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Giovanni Tincani
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Emanuele Balzano
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Paola Carrai
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Stefania Petruccelli
- Hepatobiliary surgery and liver transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Daniela Campani
- Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy; Department of Pathology, University of Pisa Medical School Hospital, Pisa, Italy
| | - Laura Crocetti
- Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy; Interventional Radiology, University of Pisa Medical School Hospital, Pisa, Italy
| | - Chiara Lazzeri
- Regional Center for Organ and Tissue Allocation, Careggi Hospital, Florence, Italy
| | - Giandomenico Biancofiore
- Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy; Anesthesiology and Intensive Care, University of Pisa Medical School Hospital, Pisa, Italy
| | - Adriano Peris
- Organizzazione Toscana Trapianti, Tuscany Region Welfare Ministry, Florence, Italy
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Fallani G, Stocco A, Siniscalchi A, Antonini MV, Stella AP, Amato A, Prosperi E, Turco L, Morelli MC, Cescon M, Ravaioli M. Beyond the Concepts of Elder and Marginal in DCD Liver Transplantation: A Prospective Observational Matched-Cohort Study in the Italian Clinical Setting. Transpl Int 2023; 36:11697. [PMID: 37736400 PMCID: PMC10511003 DOI: 10.3389/ti.2023.11697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023]
Abstract
Donation after circulatory determination of death (DCD) is a valuable strategy to increase the availability of grafts for liver transplantation (LT). As the average age of populations rises, the donor pool is likely to be affected by a potential increase in DCD donor age in the near future. We conducted a prospective cohort study to evaluate post-transplantation outcomes in recipients of grafts from elderly DCD donors compared with younger DCD donors, and elderly donors after brainstem determination of death (DBD). From August 2020 to May 2022, consecutive recipients of deceased donor liver-only transplants were enrolled in the study. DCD recipients were propensity score matched 1:3 to DBD recipients. One-hundred fifty-seven patients were included, 26 of whom (16.6%) were transplanted with a DCD liver graft. After propensity score matching and stratification, three groups were obtained: 15 recipients of DCD donors ≥75 years, 11 recipients of DCD donors <75 years, and 28 recipients of DBD donors ≥75 years. Short-term outcomes, as well as 12 months graft survival rates (93.3%, 100%, and 89.3% respectively), were comparable among the groups. LT involving grafts retrieved from very elderly DCD donors was feasible and safe in an experienced high-volume center, with outcomes comparable to LTs from younger DCD donors and age-matched DBD donors.
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Affiliation(s)
- Guido Fallani
- Department of Hepatobiliary Surgery and Transplantation, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Stocco
- Department of Hepatobiliary Surgery and Transplantation, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Department of Transplant Intensive Care Unit, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marta Velia Antonini
- Ospedale “Maurizio Bufalini”—Azienda Unità Sanitaria Locale Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Adriano Pasquale Stella
- Department of Hepatobiliary Surgery and Transplantation, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Amato
- Department of Hepatobiliary Surgery and Transplantation, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Prosperi
- Department of Hepatobiliary Surgery and Transplantation, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Laura Turco
- Department of Internal Medicine for the Treatment of Severe Organ Failure, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Cristina Morelli
- Department of Internal Medicine for the Treatment of Severe Organ Failure, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of Hepatobiliary Surgery and Transplantation, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Department of Hepatobiliary Surgery and Transplantation, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Glorion M, Sarsam M, Roux A, Stern M, Belousova N, Fessler J, Pricopi C, De Wolf J, Picard C, Brugière O, De Miranda S, Grenet D, Tachon G, Cerf C, Parquin F, Le Guen M, Chapelier A, Vallée A, Sage E. Results of Lung Transplantation for Cystic Fibrosis With Selected Donors Over 65 Years Old. Transpl Int 2023; 36:11180. [PMID: 37404718 PMCID: PMC10316425 DOI: 10.3389/ti.2023.11180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/16/2023] [Indexed: 07/06/2023]
Abstract
Lung transplantation is limited by the shortage of suitable donors. Many programs have begun to use extended criteria donors. Donors over 65 years old are rarely reported, especially for young cystic fibrosis recipients. This monocentric study was conducted for cystic fibrosis recipients from January 2005 to December 2019, comparing two cohorts according to lung donor age (<65 years or ≥65 years). The primary objective was to assess the survival rate at 3 years using a Cox multivariable model. Of the 356 lung recipients, 326 had donors under 65 years, and 30 had donors over 65 years. Donors' characteristics did not differ significantly in terms of sex, time on mechanical ventilation before retrieval, and partial pressure of arterial oxygen/fraction of inspired oxygen ratio. There were no significant differences in post-operative mechanical ventilation duration and incidence of grade 3 primary graft dysfunction between the two groups. At 1, 3, and 5 years, the percentage of predicted forced expiratory volume in 1 s (p = 0.767) and survival rate did not differ between groups (p = 0.924). The use of lungs from donors over 65 years for cystic fibrosis recipients allows extension of the donor pool without compromising results. Longer follow-up is needed to assess the long-term effects of this practice.
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Affiliation(s)
- Matthieu Glorion
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Matthieu Sarsam
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Antoine Roux
- Service de Pneumologie, Hopital Foch, Suresnes, France
- Université Paris-Saclay, UVSQ, INRAE, VIM, Jouy-en-Josas, France
| | - Marc Stern
- Service de Pneumologie, Hopital Foch, Suresnes, France
| | | | - Julien Fessler
- Département d’Anesthésiologie, Hôpital Foch, Suresnes, France
| | - Ciprian Pricopi
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Julien De Wolf
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | | | | | | | | | | | - Charles Cerf
- Service de Réanimation, Hôpital Foch, Suresnes, France
| | - Francois Parquin
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Morgan Le Guen
- Université Paris-Saclay, UVSQ, INRAE, VIM, Jouy-en-Josas, France
- Département d’Anesthésiologie, Hôpital Foch, Suresnes, France
| | - Alain Chapelier
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | | | - Edouard Sage
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
- Université Paris-Saclay, UVSQ, INRAE, VIM, Jouy-en-Josas, France
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4
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Buxeda A, Velis G, Arias-Cabrales C, Zapatero A, Burballa C, Redondo-Pachón D, Mir M, Crespo M, Pascual J, Pérez-Sáez MJ. Kidney transplantation outcomes from elderly donors after circulatory death: a comparison with elderly brain-dead donors. Clin Kidney J 2020; 14:1181-1189. [PMID: 33841864 PMCID: PMC8023186 DOI: 10.1093/ckj/sfaa114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background The use of kidneys from elderly controlled donation after circulatory death (cDCD) donors has increased significantly in recent years. Concerns about outcomes achieved with these elderly cDCD kidneys have arisen. We aimed to compare outcomes from elderly cDCD kidney transplant recipients (KTrs) and elderly donation after brain death donors (DBDs) in KTrs. Methods We conducted a single-centre retrospective study including 87 cDCD-KTrs (46 from donors ≥65 years of age and 41 from <65 years) and 126 DBD-KTrs from donors ≥65 years of age from 2013 through 2017). Young cDCD-KTrs were used as controls. The median follow-up was 27.1 months for all cDCD-KTrs and 29.7 months for DBD-KTrs ≥65 years of age. Results Donors >65 years of age represented more than half of our global cDCD cohort (52.9%). KTs from elderly cDCDs had similar rates of delayed graft function, primary non-function and vascular complications compared with young cDCD-KTrs and elderly DBD-KTrs. Short and medium-term graft survival from elderly cDCD kidneys are excellent and are comparable to those from young cDCD and elderly DBD kidneys (90% young cDCD versus 88% elderly cDCD versus 80% elderly DBD at 36 months, P = 0.962 and 0.180, respectively). Although recipients from cDCDs ≥65 years of age showed lower 3-year patient survival (78% versus 87% in elderly DBD-KTrs; P = 0.01), recipient age was the only determinant of patient survival [hazard ratio 1.10 (95% confidence interval 1.02–1.17); P < 0.01], without any influence of donor characteristics. Conclusions The use of kidneys from elderly cDCDs is increasing in Spain. Short- and medium-term graft outcomes are similar when comparing kidneys from elderly cDCDs and DBDs. Recipient age is the only determinant of patient survival. Additional studies are needed to assess long-term outcomes.
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Affiliation(s)
- Anna Buxeda
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Gonzalo Velis
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | - Ana Zapatero
- Department of Critical Care, Hospital del Mar, Barcelona, Spain.,Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Carla Burballa
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | - Marisa Mir
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
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Capri M, Olivieri F, Lanzarini C, Remondini D, Borelli V, Lazzarini R, Graciotti L, Albertini MC, Bellavista E, Santoro A, Biondi F, Tagliafico E, Tenedini E, Morsiani C, Pizza G, Vasuri F, D'Errico A, Dazzi A, Pellegrini S, Magenta A, D'Agostino M, Capogrossi MC, Cescon M, Rippo MR, Procopio AD, Franceschi C, Grazi GL. Identification of miR-31-5p, miR-141-3p, miR-200c-3p, and GLT1 as human liver aging markers sensitive to donor-recipient age-mismatch in transplants. Aging Cell 2017; 16:262-272. [PMID: 27995756 PMCID: PMC5334540 DOI: 10.1111/acel.12549] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 12/22/2022] Open
Abstract
To understand why livers from aged donors are successfully used for transplants, we looked for markers of liver aging in 71 biopsies from donors aged 12–92 years before transplants and in 11 biopsies after transplants with high donor–recipient age‐mismatch. We also assessed liver function in 36 age‐mismatched recipients. The major findings were the following: (i) miR‐31‐5p, miR‐141‐3p, and miR‐200c‐3p increased with age, as assessed by microRNAs (miRs) and mRNA transcript profiling in 12 biopsies and results were validated by RT–qPCR in a total of 58 biopsies; (ii) telomere length measured by qPCR in 45 samples showed a significant age‐dependent shortage; (iii) a bioinformatic approach combining transcriptome and miRs data identified putative miRs targets, the most informative being GLT1, a glutamate transporter expressed in hepatocytes. GLT1 was demonstrated by luciferase assay to be a target of miR‐31‐5p and miR‐200c‐3p, and both its mRNA (RT–qPCR) and protein (immunohistochemistry) significantly decreased with age in liver biopsies and in hepatic centrilobular zone, respectively; (iv) miR‐31‐5p, miR‐141‐3p and miR‐200c‐3p expression was significantly affected by recipient age (older environment) as assessed in eleven cases of donor–recipient extreme age‐mismatch; (v) the analysis of recipients plasma by N‐glycans profiling, capable of assessing liver functions and biological age, showed that liver function recovered after transplants, independently of age‐mismatch, and recipients apparently ‘rejuvenated’ according to their glycomic age. In conclusion, we identified new markers of aging in human liver, their relevance in donor–recipient age‐mismatches in transplantation, and offered positive evidence for the use of organs from old donors.
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Affiliation(s)
- Miriam Capri
- DIMES- Department of Experimental, Diagnostic and Specialty Medicine; Alma Mater Studiorum; Via S. Giacomo12 Bologna Italy
- CIG, Interdepartmental Center ‘L. Galvani’; Alma Mater Studiorum; Pzza Porta S. Donato, 1 Bologna Italy
| | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences; Università Politecnica delle Marche; Via Tronto 10/A Ancona Italy
- Center of Clinical Pathology and Innovative Therapy; INRCA-IRCCS National Institute; Via S. Margherita 5; 60124 Ancona Italy
| | - Catia Lanzarini
- DIMES- Department of Experimental, Diagnostic and Specialty Medicine; Alma Mater Studiorum; Via S. Giacomo12 Bologna Italy
| | - Daniel Remondini
- CIG, Interdepartmental Center ‘L. Galvani’; Alma Mater Studiorum; Pzza Porta S. Donato, 1 Bologna Italy
- Department of Physics and Astronomy (DIFA) and INFN Sez. Bologna; Alma Mater Studiorum; Via Berti Pichat 9/2 Bologna Italy
| | - Vincenzo Borelli
- DIMES- Department of Experimental, Diagnostic and Specialty Medicine; Alma Mater Studiorum; Via S. Giacomo12 Bologna Italy
| | - Raffaella Lazzarini
- Department of Clinical and Molecular Sciences; Università Politecnica delle Marche; Via Tronto 10/A Ancona Italy
| | - Laura Graciotti
- Department of Clinical and Molecular Sciences; Università Politecnica delle Marche; Via Tronto 10/A Ancona Italy
| | | | - Elena Bellavista
- DIMES- Department of Experimental, Diagnostic and Specialty Medicine; Alma Mater Studiorum; Via S. Giacomo12 Bologna Italy
- CIG, Interdepartmental Center ‘L. Galvani’; Alma Mater Studiorum; Pzza Porta S. Donato, 1 Bologna Italy
| | - Aurelia Santoro
- CIG, Interdepartmental Center ‘L. Galvani’; Alma Mater Studiorum; Pzza Porta S. Donato, 1 Bologna Italy
| | - Fiammetta Biondi
- CIG, Interdepartmental Center ‘L. Galvani’; Alma Mater Studiorum; Pzza Porta S. Donato, 1 Bologna Italy
| | - Enrico Tagliafico
- Center for Genome Research; Life Sciences Department; University of Modena and Reggio Emilia; Via Campi 287 Modena Italy
| | - Elena Tenedini
- Center for Genome Research; Life Sciences Department; University of Modena and Reggio Emilia; Via Campi 287 Modena Italy
| | - Cristina Morsiani
- DIMES- Department of Experimental, Diagnostic and Specialty Medicine; Alma Mater Studiorum; Via S. Giacomo12 Bologna Italy
| | - Grazia Pizza
- DIMES- Department of Experimental, Diagnostic and Specialty Medicine; Alma Mater Studiorum; Via S. Giacomo12 Bologna Italy
| | - Francesco Vasuri
- ’F. Addarii’ Institute of Oncology and Transplant Pathology at DIMES; S. Orsola-Malpighi Hospital; 40138 Bologna Italy
| | - Antonietta D'Errico
- ’F. Addarii’ Institute of Oncology and Transplant Pathology at DIMES; S. Orsola-Malpighi Hospital; 40138 Bologna Italy
| | - Alessandro Dazzi
- DIMEC-Department of General Surgery and Medicine Sciences; S. Orsola-Malpighi Hospital; 40138 Bologna Italy
| | - Sara Pellegrini
- DIMEC-Department of General Surgery and Medicine Sciences; S. Orsola-Malpighi Hospital; 40138 Bologna Italy
| | - Alessandra Magenta
- Istituto Dermopatico dell'Immacolata-IRCCS; FLMM; Vascular Pathology Laboratory; Via dei Monti di Creta 104 Rome 00167 Italy
| | - Marco D'Agostino
- Department of Experimental Medicine; Sapienza; University of Rome; Viale Regina Elena 324 Rome 00161 Italy
| | - Maurizio C. Capogrossi
- Istituto Dermopatico dell'Immacolata-IRCCS; FLMM; Vascular Pathology Laboratory; Via dei Monti di Creta 104 Rome 00167 Italy
| | - Matteo Cescon
- DIMEC-Department of General Surgery and Medicine Sciences; S. Orsola-Malpighi Hospital; 40138 Bologna Italy
| | - Maria Rita Rippo
- Department of Clinical and Molecular Sciences; Università Politecnica delle Marche; Via Tronto 10/A Ancona Italy
| | - Antonio Domenico Procopio
- Department of Clinical and Molecular Sciences; Università Politecnica delle Marche; Via Tronto 10/A Ancona Italy
- Center of Clinical Pathology and Innovative Therapy; INRCA-IRCCS National Institute; Via S. Margherita 5; 60124 Ancona Italy
| | - Claudio Franceschi
- IRCCS; Institute of Neurological Sciences of Bologna; Bologna 40139 Italy
| | - Gian Luca Grazi
- Istituto Nazionale Tumori ‘Regina Elena’; Via Elio Chianesi 53 Roma 00144 Italy
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6
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Westerkamp AC, Korkmaz KS, Bottema JT, Ringers J, Polak WG, van den Berg A, van Hoek B, Metselaar HJ, Porte RJ. Elderly donor liver grafts are not associated with a higher incidence of biliary complications after liver transplantation: results of a national multicenter study. Clin Transplant 2015; 29:636-43. [PMID: 25997000 DOI: 10.1111/ctr.12569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Liver transplantation with livers grafts from elderly donors has been associated with a higher risk of biliary complications. The aim of this study was to examine whether our national protocol could contribute to a lower incidence of biliary complications. METHODS All adult recipients in the Netherlands transplanted with a liver from an elderly donor (≥ 65 yrs; n = 68) in the period January 2000-July 2011 were matched with recipients of a liver from a donor <65 yr (n = 136). Outcome parameters were 90-d, one-yr, and three-yr patient/graft survival rates, biliary complications (non-anastomotic stricture, anastomotic stricture, biliary leakage, and post-transplant cholangitis), and postoperative hepatic ischemic injury serum markers (AST/ALT). RESULTS The median cold ischemia time (CIT) was 7:25 (h:min) in the group recipients of an elderly donor liver graft. Ninety-day, one-yr, and three-yr patient/graft survival rates were similar between the group with an elderly donor liver and their younger controls. Moreover, no differences were found in the incidence of biliary complications and postoperative levels of AST/ALT between the two groups. CONCLUSION Transplantation of livers from elderly donors (≥ 65 yr) is not associated with a higher incidence of biliary complications, in a national policy wherein the CIT is kept short.
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Affiliation(s)
- Andrie C Westerkamp
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kerem S Korkmaz
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan T Bottema
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Ringers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wojciech G Polak
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Aad van den Berg
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert J Porte
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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