The use of older donor livers is associated with more severe preservation injury following liver transplantation

Abstract

Donor age is a risk factor for the development of initial poor graft function after liver transplantation (LT). Histological preservation injury (PI) in day 0 postperfusion (0Post) liver graft biopsies predicts subsequent PI in the early postoperative period. This study was performed to assess whether donor age was a risk factor for the development of PI in 0Post biopsies. Methods: The records of 94 LT performed at our institution between January 1991 and July 1996, were reviewed. 0Post biopsies were obtained immediately after graft revascularization. The severity of PI was graded according to Kakizoe's scheme: grade 0= none; 1= minimal; 2= mild; 3= moderate; 4-severe. Liver grafts were defined as older when originating from a donor age 50 years and older. Other variables also examined using univariate and multivariate analysis as potentially associated with the severity of PI in 0Post biopsies included donor cause of death, length of hospital stay, acidosis (pH 33% but 66% of hepatocytes). Results: Of the grafts studied, 88% were used for a first and 12% for a second LT. Mean donor age was 34 _+ 16 years old. 17% of grafts originated from older donors. The PI observed in 0Post biopsies was grade 0 in 25% of grafts, grade 1 in 21%, grade 2 in 37%, grade 3 in 12%, and grade 4 in 4%. Older grafts were associated with higher grades of PI than younger ones (2.3 + 1.0 vs 1.3 -+ 1.1; p= 0.003). The cause of death of older donors differed from that of younger donors (eva 73% vs 35%, trauma 20% vs 47%, other 13% vs 18% respectively; XZ= 6.40, p= 0.04). Older grafts showed higher grades of steatosis (0.4-+0.5 vs 0.1 -+0.4; p= 0.03). Multivariate analysis with an F-to-remove test at a significance level of p= 0.05 identified donor age 50 years and older as the only significant predictive variable of the severity of PI on 0Post biopsies (p= 0.02). Conclusions: The use of older liver grafts is associated with more severe PI immediately after graft reperfusion. Whether this early lesion identifies amongst recipients of older grafts those at greater risk of increased morbidity and graft loss after LT, remains to be determined.