Abstract
BackgroundDonor age is an important predictor for liver transplant recipients. Studies have not fully explored its impact on transplant outcomes in hepatocellular carcinoma (HCC) patients as well as its involvement in tumor recurrence.MethodsHCC patients who received liver transplants during 2010–2017 from the Scientific Registry of Transplant Recipients database were included. The recipients were divided into four groups based on donor age: I (≤ 34 years), II (35–49 years), III (50–64 years), and IV (≥ 65 years). Transplant outcomes, including the overall survival (OS), tumor recurrence, and risks, were evaluated.ResultsA total of 13,276 HCC recipients were included in this study. Statistical significant differences were observed in OS among the four groups. The best 5-year survival was 76.0% in group I, followed by 73.5% in group II, 72.8% in group III, and 69.2% in group IV (P < 0.001). However, the liver-specific survival did not differ among these groups (P = 0.260). Donor age was found to be the independent predictor of OS after adjusting for other variables (P < 0.001, ref. group I; 1.087 (0.979–1.208) for group II, P = 0.119; 1.124 (1.015–1.246) for group III, P = 0.025; 1.395 (1.215–1.602) for group IV, P < 0.001). In subgroup analysis, OS was significantly different in recipients with hepatitis C virus (HCV), but there was no significant difference for recipients with hepatitis B virus (HBV), alcoholic liver diseases and nonalcoholic steatohepatitis (NASH). The post-transplant cumulative tumor recurrence rates were similar among the four groups (P = 0.382).ConclusionsOlder donor age was associated with decreased OS but not liver-specific survival as well as post-transplant tumor recurrence in HCC recipients. Donor age also had different effects in patients with different underlying liver diseases.
Highlights
Donor age is an important predictor for liver transplant recipients
In this study, we demonstrated that the overall survival (OS) differed in hepatocellular carcinoma (HCC) liver transplant recipients categorized according to different donor ages, whereas donor age had no effect on post-transplant tumor recurrence
Our study demonstrated that older donor age was associated with statistical inferior OS in transplant recipients with HCC, the actual survival differences were minimal
Summary
Donor age is an important predictor for liver transplant recipients. Studies have not fully explored its impact on transplant outcomes in hepatocellular carcinoma (HCC) patients as well as its involvement in tumor recurrence. There are concerns regarding the application of old liver grafts in clinical practice, as liver tissue from older donors would undergo a series of morphological and physiological changes, making it more vulnerable to ischemia–reperfusion injury (IRI) during transplantation [5]. These pathophysiological changes would lead to adverse effects on recipient prognosis. Feng et al evaluated the effects of donor-related variables on transplant outcomes and demonstrated that donor age was an independent predictor of overall survival (OS) [6]. With an increasing application of liver grafts from older donors and improved surgical techniques as well as perioperative managements, a number of studies have recently shown the safety of use of old donor livers, even using livers from octogenarian donors [4, 7]
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