Impact of Recipient Age On Long-Term Outcomes in Visceral Transplants.

Abstract

Background: Recipient age has a significant impact on long-term outcomes following visceral transplantation (VTx). Pediatric recipients present with certain technical challenges related to size whereas older recipients could have age-related comorbid conditions, particularly preexisting cardiac, vascular, renal and pulmonary disease. We studied the impact of recipient age on long-term outcomes after VTx. Methods: A total of 200 VTx were performed between 7/2003-10/2013, including full multivisceral Tx (MVTx, n=120), modified MVTx (MMVTx, n=24), and isolated small bowel Tx (ISBTx, n=56). There were 16 (8%) re-Tx and included in this analysis. 6 different age groups (<2, 2-17, 18-39, 40-49, 50-59, and >60 years) were compared with 5-year (y) follow-up. All graft survival curves were calculated as non-death censored. Results: There was no significant difference in graft or patient survival across all transplant types. For MVTx, graft and patient survival correlated very closely. All MMVTX recipients were ≥18y. While graft and patient survival correlated closely in MMVTx in recipients >50y, this was not the case for younger recipients where patient survival was better than the older recipients while graft survival rates were similar or worse. For ISBTx, in pediatric recipients ≥2y, 89% 5y patient survival was achieved with 67% graft survival. For ISBTx recipients >40y and pediatric recipients <2y, patient and graft survival correlated very closely. In ISBTx, the worst graft survival was observed in age group 18-39y at 5y (23%) and this didn't correlate with patient survival which was 56% at 5yFigure: No Caption available.Conclusion: This is the first detailed report of impact of recipient age on outcome following VTx in a large single center series. The youngest age groups for ISBTx and MMVTx can potentially achieve outstanding patient survival rates at 5y. Graft loss out of proportion to patient survival is more common in younger recipients and likely reflects immunological graft loss with timely re-Tx. MVTx can be done in all age groups after careful selection with comparable outcomes, when it is indicated.