Differences In Recipient Age Research Articles

Safety and use of late-turndown liver allografts to increase rate of transplantation

BackgroundThe demand for liver transplants (LT) in the United States far surpasses the availability of allografts. New allocation schemes have resulted in occasional difficulties with allograft placement and increased intraoperative turndowns. We aimed to evaluate the outcomes related to use of late-turndown liver allografts. MethodsA review of prospectively collected data of LTs at a single center from July 2019 to July 2023 was performed. Late-turndown placement was defined as an open offer 6 h prior to donation, intraoperative turndown by primary center, or post-cross-clamp turndown. ResultsOf 565 LTs, 25.1% (n = 142) received a late-turndown liver allograft. There were no significant differences in recipient age, gender, BMI, or race (all p > 0.05), but MELD was lower for the late-turndown LT recipient group (median 15 vs 21, p < 0.001). No difference in 30-day, 6-month, or 1-year survival was noted on logistic regression, and no difference in patient or graft survival was noted on Cox proportional hazard regression. Late-turndown utilization increased during the study from 17.2% to 25.8%, and median waitlist time decreased from 77 days in 2019 to 18 days in 2023 (p < 0.001). ConclusionUse of late-turndown livers has increased and can increase transplant rates without compromising post-transplant outcomes with appropriate selection.

Duration of Dialysis in Acute Kidney Injury Donors and Transplant Outcomes.

Acute kidney injury (AKI) kidneys, including those from donors on dialysis, are often underutilized, although there is increasing data available demonstrating good transplant outcomes. To date, data on the duration of donor dialysis and transplant outcomes are limited. This was a single-center study of deceased donor kidney transplants from 2010 to 2022. The study cohort consisted of recipients of deceased donor kidney transplants from donors with AKI and on dialysis. Three groups were identified based on the predetermined interquartile range of donor dialysis duration: 1 to 2 dialysis days, 3 to 4 dialysis days, and 5 or more dialysis days. During this period, 765 AKI deceased donor transplants were performed, of which 230 were from donors on dialysis. The median dialysis duration was 2 days with a maximum of 13 days. Across the 3 groups, there were no differences in recipient age (p = 0.23) or dialysis vintage (p = 0.70). Donor age (p = 0.86) and kidney donor profile index (p = 0.57) were comparable between the groups. Recipients of deceased donor kidney transplants from donors on dialysis 5 or more days had lower terminal creatinine levels (p = 0.003) and longer cold ischemia times (p = 0.04). Posttransplant, the median length of hospital stay was 3 days for all groups (p = 0.75). There were no differences in delayed graft function occurrence (94.4% vs 86.8% vs 92.1%, p = 0.19), duration of delayed graft function (p = 0.56), or readmissions (p = 0.99). At 1 year posttransplant, the estimated glomerular filtration rate (p = 0.76), patient survival (p = 0.82), or death-censored graft survival (p = 0.28) were comparable. Excellent outcomes have been observed in AKI deceased donor kidney transplants, including those coming from donors on dialysis. In this small cohort, the duration of donor dialysis did not adversely affect outcomes. Cautious expansion of the donor pool, including donors on dialysis, should be considered given the ongoing organ shortage.

MO1007: Intestinal Permeability in Patients After Kidney Transplantation Treated with Two Different Formulations of Extended-Release Tacrolimus

Abstract BACKGROUND AND AIMS A prompt achieving of adequate tacrolimus blood exposure is crucial in early period after kidney transplantation. A gut epithelial barrier integrity may play a role in tacrolimus absorption. The aim of this study was to investigate the intestinal fatty acid binding protein (I-FABP) concentrations as a marker of intestinal permeability in recent kidney transplant recipients (KTRs) treated with two different tacrolimus extended-release formulations. METHOD 48 pairs of consecutive KTRs were analyzed. Within each pair, an early conversion was performed from twice-daily (Prograf) to a once-daily tacrolimus formulation: Advagraf or Envarsus. On the day of discharge from the hospital, I-FABP plasma levels were measured and the tacrolimus concentration-to-dose (C/D) ratio was calculated. Tacrolimus exposure was assessed with an area under the curve (AUC) based on blood trough level and 3-h post-dose measurement. RESULTS There were no differences in recipient age, dialysis vintage, BMI and residual diuresis between the Advagraf and Envarsus groups. The median I-FABP plasma levels [Advagraf: 1450 (750–2100) versus Envarsus 1200 (600–1790) pg/mL; P = .18] and mean tacrolimus AUC [154 (143–164) versus 145 (132–158) ng.h/mL, respectively; P = .30] were similar. As expected, C/D ratio was significantly greater in the Envarsus group [2.06 (1.32–3.09) versus 1.16 (0.72–1.52) in the Advagraf group; P &amp;lt; .001]. Interestingly, log I-FABP correlated inversely with tacrolimus AUC only in the Envarsus group (r = –0.431; P &amp;lt; .01) but not in the Advagraf group (r = 0.05; P = .72). CONCLUSION Our findings suggest that destabilization of the enterocyte membrane integrity may influence the intestinal tacrolimus absorption, which may cause lower tacrolimus exposure in KTRs treated with Envarsus. However, explanation of this phenomenon needs further investigation.

Predicting Cardiac Allograft Vasculopathy Profiles Using Machine Learning Clustering

<h3>Purpose</h3> Cardiac Allograft Vasculopathy (CAV) is the leading cause of graft dysfunction in heart transplantation (HT). Identifying CAV profiles is critical in determining the intensity of surveillance required to appropriately prevent and treat this complication. We sought to identify CAV profiles using maximal intimal thickness (MIT) and a latent-class mixed-effect regression model. <h3>Methods</h3> This analysis includes an adult HT patients from a single centre from 2010 to 2018. Latent class mixed-effect regression models were used to simultaneously identify latent classes (or clusters) of MIT trajectories post-HT and to quantify risk factors associated with the cluster membership. The outcome of interest was MIT from baseline (0-6 months) to 5 years after HT. We considered recipient and donor age, sex, and ischemic time as risk factors. We subsequently characterized the association between the clusters and ISHLT CAV grade using a competing risk model. <h3>Results</h3> Overall 186 consecutive adult HT recipients, predominantly male (70%), Caucasian (58%), 54 (43-61) years of age were included. In a covariate-adjusted model, 4 CAV profiles were identified (Figure 1A). Class 1 and 2 consisted of patients with stable MIT over time; patients in Class 3 and 4 experienced elevated MIT. Patients in Class 3 had a lower MIT and slower progression than those in Class 4. There were significant between-class differences in recipient age (p=0.002), recipient sex (p=<0.001), ischemic time (p<0.001), and donor age (p<0.004). Moreover, Figure 1B shows that recipients in Class 3 and 4 had a significantly higher proportion of CAV at 5 years compared to Class 1 and 2 (p< 0.001). <h3>Conclusion</h3> This work builds on previous ML models to differentiate trajectories of CAV using MIT. In our model, MIT at baseline and year-1, in addition to baseline demographics, can be used to discriminate the progression of CAV at 5 years. Recipients in CAV Class 3 and 4 would benefit from more intensive surveillance and early CAV directed therapies.

Impact of side-to-side cavocavostomy versus traditional piggyback implantation in liver transplantation

BackgroundTraditional piggyback implantation has often been used in liver transplant; however, this technique may be hindered by difficult visualization and postoperative incidences of outflow obstruction. Side-to-side cavocavostomy is an alternative approach, but perioperative outcomes associated with this technique remain largely unknown. MethodsIn July 2017, side-to-side cavocavostomy was adopted as the standard implantation technique at our institution by all surgeons (n = 4). A prospective cohort of patients undergoing liver transplant with side-to-side cavocavostomy after July 2017 until October 2018 was compared with a historical cohort of patients who underwent liver transplant with traditional piggyback previously from January 2016 to October 2018. ResultsOf 290 liver transplant patients, 50% (n = 145) underwent side-to-side cavocavostomy, while the remainder underwent traditional piggyback. There were no differences in recipient age, sex, race, Model for End-Stage Liver Disease score, or donor characteristics between groups. Side-to-side cavocavostomy was associated with decreased mean number intraoperative, red blood cell transfusions (2 vs 5 units), fresh frozen plasma (5 vs 10 units), cell saver (1.0 vs 2.0 L), and rates of temporary abdominal closure (8.3% vs 24.1%) compared with traditional piggyback (all P < .05). The side-to-side cavocavostomy group had lesser Rt3s of postoperative transfusion rates of red blood cells (21.4% vs 35.9%; P = .01). ConclusionSide-to-side cavocavostomy may be superior to traditional piggyback implantation with regard to technical ease and perioperative transfusion requirements. To determine the optimal implantation technique, futures studies should evaluate side-to-side cavocavostomy versus traditional piggyback in a prospective, multicenter, randomized approach.

P1619OUTCOME OF HIGH DONOR-RECIPIENT AGE GAP IN LIVE-DONOR RENAL TRANSPLANTS IN TACROLIMUS ERA

Abstract Background and Aims High donor-recipient age gap among deceased-donor renal transplant patients leads to worse outcomes. However, the impact of this gap among live-donor renal transplants is unclear. The aim of this study is to assess the effect of this age gap on graft survival and acute rejection rates among renal transplants in tacrolimus era. Method 14390 live-donor renal transplant patients who received a single organ transplant, had no previous renal transplants, discharged on tacrolimus-based immunotherapy and were registered in the Organ Procurement Transplantation Network from January 2000 till June 2017 were included in the study. Donor–recipient age difference was divided into 5 groups; group A (difference &amp;lt;−10,n=4375), group B (difference from -10 to 10,n=7229), group C (difference between 10-20, n=861), group D ( difference between 20–29, n=1406) and group E (difference ≥30 years, n=519). Poisson regression analysis was used to assess effect of age gap on acute rejection rates. Kaplan-Meier survival curves and Cox hazard regression analysis were used to assess this effect on graft survival. Results Regarding graft survival, groups with age difference ≥30 years and between 20-29 years showed a significantly higher risk of graft loss when compared to group with age difference &amp;lt;−10 (HR equals 4.6 and 3.8 respectively). Groups with age difference between 10 to 20 years and between -10 to 10 years showed no significant difference in graft survival when compared to same group (HR equals 1.03 and 0.95 respectively). Groups B,C,D,E were not associated with increased risk of acute rejection episodes when compared to group A (IRR=1.001, 1.001, 1.022, 1.027 respectively). Conclusion Donor-recipient age difference up to 20 years has similar renal transplant outcomes to those receiving kidneys from younger donors and therefore, should not be precluded from paired kidney donation programs. The donor-recipient age difference above 20 years is associated with worse outcomes in terms of graft survival.

Lower risk of graft dislocation applying organ cultured corneas compared with cold short-term cultured corneas during DSAEK surgery.

To investigate factors that may affect graft dislocation after uneventful Descemet stripping endothelial keratoplasty (DSAEK), with a special focus on different donor cornea storage conditions. All DSAEK surgeries performed during 6 years in our hospital were retrospectively investigated. Patients with previous intraocular surgeries other than cataract extraction were excluded. Donor data (age, gender, death-to-preservation time, cornea storage conditions, graft storage time, and estimated thickness of the graft) and patient information (age, gender, and indication for surgery) were noted. A total of 26 dislocations (6.6%) out of 394 DSAEK surgeries were found. The dislocation rate was considerably reduced between 2011 and 2016, due to more experienced surgeons. There was a significantly higher dislocation rate with the use of donor corneas stored in cold storage solution (12.7%) compared with organ culture solution (2.5%) (P < 0.001). During the study period, donor corneas stored in cold storage solution and organ culture solution were applied in 158 (40%) and 236 (60%) cases, respectively. There were no differences in recipient age and gender between patients who received corneas from the two storage systems, indicating a random distribution of grafts. In a multivariate analysis, only operation year (reduced rate over the years) and cold storage solution were statistically significantly associated with graft dislocation. This study suggests that the type of storage solution may have a decisive role in graft dislocation in DSAEK surgery.

Outcomes in Hepatocellular Carcinoma Liver Transplantation before and after the Mandated Six-Month Wait Time

The United Network for Organ Sharing (UNOS) implemented a policy that requires patients with hepatocellular carcinoma seeking liver transplantation to wait six months before being granted Model for End-Stage Liver Disease exception points. We investigated the difference in resource utilization between patients who underwent liver transplantation before and after the present policy. We conducted a retrospective cohort study of adult liver transplants from 2013 to 2018. Patients were classified into prepolicy or postpolicy groups based on 964 days before or after the wait-time policy. We also retrieved national survival outcome data from United Network for Organ Sharing. Differences across compared groups for continuous variables were assessed using the independent sample t test, and the chi-squared test was used for binary variables. We found statistical differences in recipient age (P = 0.005), days on wait-list (P = 0.001), sustained virological response (P < 0.001), and hepatocellular carcinoma recurrence one year posttransplant (P = 0.04). There were statistically significant differences in the number of treatment days pretransplant and length of transplant admission stay, indicating an increase in resource utilization in the postpolicy group. No statistically significant differences were found between groups in one-year graft or patient survival despite an observed increase in resource utilization by the hepatocellular carcinoma postpolicy group.

Heart transplant outcomes in recipients of Centers for Disease Control (CDC) high risk donors.

A lack of donor hearts remains a major limitation of heart transplantation. Hearts from Centers for Disease Control (CDC) high-risk donors can be utilized with specific recipient consent. However, outcomes of heart transplantation with CDC high-risk donors are not well known. We sought to define outcomes, including posttransplant hepatitis and human immunodeficiency virus (HIV) status, in recipients of CDC high-risk donor hearts at our institution. All heart transplant recipients from August 2010 to December 2014 (n = 74) were reviewed. Comparison of 1) CDC high-risk donor (HRD) versus 2) standard-risk donor (SRD) groups were performed using chi-squared tests for nominal data and Wilcoxon two-sample tests for continuous variables. Survival was estimated with Kaplan-Meier curves. Of 74 heart transplant recipients reviewed, 66 (89%) received a SRD heart and eight (11%) received a CDC HRD heart. We found no significant differences in recipient age, sex, waiting list 1A status, pretransplant left ventricular assist device (LVAD) support, cytomegalovirus (CMV) status, and graft ischemia times (p = NS) between the HRD and SRD groups. All of the eight HRD were seronegative at the time of transplant. Postoperatively, there was no significant difference in rejection rates at six and 12 months posttransplant. Importantly, no HRD recipients acquired hepatitis or HIV. Survival in HRD versus SRD recipients was not significantly different by Kaplan-Meier analysis (log rank p = 0.644) at five years posttransplant. Heart transplants that were seronegative at the time of transplant had similar posttransplant graft function, rejection rates, and five-year posttransplant survival versus recipients of SRD hearts. At our institution, no cases of hepatitis or HIV occurred in HRD recipients in early follow-up.

Dobutamine stress echocardiography after cardiac transplantation: implications of donor-recipient age difference.

Dobutamine stress echocardiography (DSE) is widely used during follow-up after cardiac transplant for the diagnosis of allograft vasculopathy. We investigated the effect of donor–recipient age difference on the ability to reach target heart rate (HR) during DSE.All cardiac transplant patients who were undergoing DSE over a 3-year period in a single institution were reviewed. Target HR was specified as 85%×(220 – patient age). Further patient and donor demographics were obtained from the local transplant database.61 patients (45 male, 55±12 years) were stressed with a median dose of 40 mcg/kg per min dobutamine. Only 37 patients (61%) achieved target HR. Donor hearts were mostly younger (mean 41±14 years, P<0.001), with only 11 patients (18%) having donors who were older than they were. Patients with older donors required higher doses of dobutamine (median 50 vs 30 mcg/kg per min, P<0.001) but achieved a lower percentage target HR (mean 93% vs 101%, P=0.003) than those with younger donors did. Patients with older donors were less likely to achieve target HR (18% vs 67%, P=0.003).In conclusion, donor–recipient age difference affects the likelihood of achieving target HR and should be considered when a patient is consistently unable to achieve ‘adequate’ stress according to the patient's age.

(33) - Donor to Recipient Age Difference in Weight-Matched Pediatric Heart Transplants Predicts Mortality

Donors are matched on weight for pediatric heart transplant (PHT), however, age differences are not considered in this decision. This study attempts to identify age differences in weight matched PHT and its effect on post-transplant survival.

Effect of donor–recipient age difference on long-term graft survival in living kidney transplantation

We aimed to examine the influence of donor age on living-donor kidney transplantation (KTx), particularly with regard to long-term graft survival in young recipients with aged kidney grafts. Between 1988 and 2012, 287 living-donor KTxs were performed in our center. The recipients were divided into 3 groups according to age in years: under 30 (young), 30-49 (middle-aged), and over 50 (old). The data regarding the influence of kidneys from donors aged over 50 years were retrospectively analyzed. Graft survival at 1, 5, 10, and 15 years was 94.7, 94.7, 90.2, and 75.2%, respectively, in young recipients who received grafts from donors aged under 50 years, and 96.4, 91.9, 65.4, and 41.4%, respectively, in young recipients who received grafts from donors aged over 50 years (P = 0.023). In contrast, there were no significant differences regarding graft survival and donor age in the middle-aged and old recipient groups. Multivariate analysis revealed that young recipient and rejection episode were significant predictors of graft loss in transplantation from older donors. Histological examination revealed significant age-related changes in the grafts before transplant and a significant higher rate of glomerular hypertrophy at the 1-month protocol biopsy in young recipients with aged kidney grafts. Kidney grafts from older living donors affected long-term graft survival in young recipients. In addition to the damage from rejection, aged kidney grafts, which have less nephron mass, may have a limited capacity to appropriately respond to increases in physiological or metabolic demands of young recipients, leading to a greater reduction in renal function.

Does donor–recipient age difference matter in outcome of kidney transplantation? Implications for kidney paired donation

Background: Kidney paired donation (KPD) is a rapidly growing modality for facilitating living donor kidney transplantation (LDKTx) for patients who are incompatible with their healthy, willing and living donor. The impact of donor–recipient age difference on long and short-term graft and patient survivals in LDKTx is still uncertain. Methods: A total of 1502 LDKTx recipients who received regular follow-up in our center from 1999 to 2012 were studied. Donor–recipient age difference was divided into subgroups (donor–recipient 0−10, 11–20, 0–20, 21–30, 31–40, and 21–40 years). Outcome measures included death censored graft, patient survival and acute rejection rate. Results: The 1-, 5-, 10-year patient survival of the donor–recipient age difference ≤20 years group showed no difference compared with the age difference >20 years group (94.5%, 83.2%, 71.9% and 95.2%, 86%, 77.8%, p = 0.053). The 1-, 5-, 10-year graft survival of the donor–recipient age difference ≤20 years group showed no difference compared with the age difference >20 years group (94.6%, 81.6%, 72.1% and 94%, 80%, 72.2%, p = 0.989). The rejection were also similar (17.5% vs. 16.5%, p > 0.05). There was no statistically significant difference in graft survival and acute rejection rate in all subgroups. Conclusions: Older donors (usually within families) are not associated with worse outcome is reassuring. KPD should not be prohibited due to high donor–recipient age difference, when size of donor pool is small as in single center KPD program.

Impact of donor and recipient age difference on long‐term allograft survival after living donor renal transplantation: analysis of 478 cases

Either deceased or living-related renal transplantation constitutes the best therapeutic option for patients with end-stage renal disease. In this retrospective study, an attempt to identify parameters that affect allograft survival in living donor renal transplantation was made. Between January 2000 and July 2012, 478 adult patients received a renal transplant from a living-related donor in our center and their records were retrospectively reviewed in November 2012. Data concerning donor age, recipient age, donor/recipient age difference, donor/recipient gender, and ABO compatibility/incompatibility were recorded and associated with renal allograft survival rate. Renal allograft survival rate was 96%, 89.5%, and 77.7% in the first, fifth, and 10th yr after transplantation, respectively. Only the difference between donor and recipient age was statistically significant in relation to graft survival. In cases with age difference >13 yr, graft survival rate was lower from the third yr onward. Only the age difference between donor and recipient exerts an adverse impact on graft outcome after living donor renal transplantation, whereas donor age, recipient age, donor/recipient gender, and ABO incompatibility do not significantly influence renal allograft survival.

Selective policy of inferior right hepatic vein reconstruction in right lobe living donor liver transplantation does not affect post-transplant graft outcomes

Background: Over a third of donors assessed for right lobe living donor liver transplantation (LDLT) have one or more significant inferior right hepatic veins (IRHV) contributing to the drainage of the right posterior sector. While some centres routinely reconstruct them in the recipient, we follow a selective policy of reconstruction of IRHV based on size of IRHV and extent of congestion in the graft.Aim: To compare the early outcomes of transplanting right lobe grafts without IRHV, with IRHV but not reconstructed and with IRHV which were reconstructed.Methods: Data of all adult right lobe living donor liver transplants (rl-LDLT) between Jan 2010 and August 2012 were analysed. Patients were classified as those receiving grafts without IRHV (wIRHV), grafts with IRHV which were not reconstructed (nIRHV) and grafts with IRHV which were reconstructed (rIRHV). Differences in early post-operative outcomes and incidence of complications were compared within the three groups. The statistical significance of the differences was evaluated using ANOVA.Results: Data from 51 rl-LDLT grafts were analysed. IRHV was demonstrated at donor surgery in 19 (37%) cases. Amongst these, the IRHV was reconstructed in 6 patients (11.7%) while it was ligated in the remaining 13 (25.5%) patients. There was no significant differences in recipient age, recipient BMI, MELD score, donor age, donor BMI, GRWR at surgery or cold ischemia times between the three groups. There was no significant difference in peak liver biochemical tests (peak AST, ALT, bilirubin), peak INR, prolonged ascites drainage, incidence of post-operative ‘small for size syndrome’, need for renal support, infections, hospital stay or mortality.Conclusion: A selective policy of IRHV reconstruction does not adversely affect post-operative graft outcomes in adult right lobe LDLT. Background: Over a third of donors assessed for right lobe living donor liver transplantation (LDLT) have one or more significant inferior right hepatic veins (IRHV) contributing to the drainage of the right posterior sector. While some centres routinely reconstruct them in the recipient, we follow a selective policy of reconstruction of IRHV based on size of IRHV and extent of congestion in the graft. Aim: To compare the early outcomes of transplanting right lobe grafts without IRHV, with IRHV but not reconstructed and with IRHV which were reconstructed. Methods: Data of all adult right lobe living donor liver transplants (rl-LDLT) between Jan 2010 and August 2012 were analysed. Patients were classified as those receiving grafts without IRHV (wIRHV), grafts with IRHV which were not reconstructed (nIRHV) and grafts with IRHV which were reconstructed (rIRHV). Differences in early post-operative outcomes and incidence of complications were compared within the three groups. The statistical significance of the differences was evaluated using ANOVA. Results: Data from 51 rl-LDLT grafts were analysed. IRHV was demonstrated at donor surgery in 19 (37%) cases. Amongst these, the IRHV was reconstructed in 6 patients (11.7%) while it was ligated in the remaining 13 (25.5%) patients. There was no significant differences in recipient age, recipient BMI, MELD score, donor age, donor BMI, GRWR at surgery or cold ischemia times between the three groups. There was no significant difference in peak liver biochemical tests (peak AST, ALT, bilirubin), peak INR, prolonged ascites drainage, incidence of post-operative ‘small for size syndrome’, need for renal support, infections, hospital stay or mortality. Conclusion: A selective policy of IRHV reconstruction does not adversely affect post-operative graft outcomes in adult right lobe LDLT.

Effect of Blood Transfusion on Liver Transplant Outcome in Adult Patients

Introduction: Requirement of blood transfusions during liver transplantation (LT) has been reduced by refinements in patient selection, transfusion methods, and surgical technique. LT with limited volume of blood product is the current clinical practice. The aim of this study was to analyze the effect of intra-operative red blood cell (RBC) transfusion volume on liver transplant outcome in adult patients. Methods: Two thousands two hundreds twenty eight adult patients were selected from our database. Out of 2228, 1960 patients were included for this study. Fifty one patients were selected as group 1 (G1) due to no RBC transfusion, 1557 patients as group 2 (G2) due to the 1-20 units of RBC transfusion, and 352 patients as group 3 (G3) due to more than 20 units of RBC transfusion during LT surgery. Aprotinin was not used. Auto transfusion of blood salvaged was used routinely. Independent factors were analyzed with Cox hazard regression analysis to find a link with survival. Survival curve was generated by Kaplan Meier methods and compared with log rank test. Results: There were statistically significant differences in recipient age (G1: 50.5 yrs., G2: 52.9 yrs., G3: 54.3 yrs.), pre-transplant creatinine (G1: 0.9 mg/dl, G2: 1.25 mg/dl, G3: 1.56 mg/dl), cold ischemic time (G1: 429 min, G2: 446 min, G3; 477min), and warm ischemic time (G1: 37.0 min, G2: 37.8 min, G3; 40.5min). There were no statistically significant differences in demographic factors including donor age, primary liver diagnosis, MELD score, INR, bilirubin, volume of auto-transfusion and cava reconstruction methods between the groups. One, 3, 5 years' patient survival were G1: 92% 86% 80% G2: 87% 79%, 73% and G3: 73% 70% 62%. One, 3, 5 years' graft survival were G1: 92% 86% 79% G2: 83% 73% 68% and G3: 70% 63% 59%. There was statistical difference in patient and graft survival between the groups (p< 0.05). Amounts of transfusion between the groups had survival impact (Hazard ratio 1.3, 95% CI 1.12-1.51, P< 0.05). Conclusion: Recipient age and pre-transplant creatinine had impact on the RBC transfusion volume. To the contrary, recipient MELD score, primary liver disease, donor age and method of caval reconstruction had no significant impact. Amount of transfusion had an impact on the patient and graft survival.Figure: [Patient Survival]

Donor-Recipient Age Difference and Graft Survival in Living Donor Kidney Transplantation

BackgroundIn paired living kidney exchange donation from an old donor to a young recipient, it may be argued that elderly donors provide an inferior quality kidney. However, the impact of donors older than recipients on transplant outcomes remains unclear. MethodsWe retrospectively reviewed the charts of primary living kidney transplantation patients who were divided into two groups based on the age difference between donor and recipient (recipient age subtracted from donor age, donor-recipient < 20 vs ≥ 20). The donor-recipient age difference < 20 group comprised 75 and donor-recipient age difference ≥ 20 group, 25 subjects. Outcome measures included serum creatinine, acute rejection episodes as well as graft and patient survivals at 1 and 5 years after transplantation. ResultsThe mean donor age difference cohorts of < 20 and ≥ 20 years showed donor ages of 33 ± 8 and 54 ± 8 years, respectively. The mean recipient age in both groups averaged under 40 years. The acute rejection rate within the first year posttransplantation was greater among age difference ≥ 20 years. The mean serum creatinine values of the donor-recipient age difference < 20 group was lower than the ≥20 years group at 1 and 5 years posttransplant. The 1-year difference was associated with an increased creatinine value at 5 years. However, death-censored graft survival of the age difference of the ≥ 20 years group was not different (hazard ratio [HR] = 0.1, 95% confidence interval [CI] = 0.01–1.37, P = .08). Patient survival of the age difference ≥ 20 years group showed no difference compared with the age difference < 20 years group (HR = 0.25, 95% CI = 0.01–6.35, P = .4). ConclusionAlthough the cohort of a donor-young recipient age difference ≥ 20 years showed a greater risk of an acute rejection episode early posttransplantation, it did not affect graft or patient survivals. When considering paired kidney donation, older age donors should not necessarily be limited.

Long-Term Outcome in Heart Transplant Patients With Pretransplant Malignancies

Introduction Neoplasms have classically been considered a contraindication for heart transplantation (HT) because of the possibility of recurrence during immunosuppressive therapy. There are few cases of patients who suffered a pretransplant malignancy (PTM); however the appropriate interval free of a malignancy (IFoM) before heart transplantation is unclear. Our study sought to determine the long-term outcomes after transplantation among patients who had suffered a prior neoplasm compared with our overall cohort. Methods This retrospective, single-center study included 595 heart transplant recipients ungrafted between 1991 and 2009. We determined PTM location, histology, and IFoM. We examined donor and recipient factors and post-HT data of rejections, infections, neoplasms, and survival associated with a poor prognosis. Results Twelve patients with different types, locations, and histological grades of PTM represented 66.7% women versus 16.1% women in the overall series ( P < .01). There were no differences in recipient age or clinical characteristics (diabetes mellitus, arterial hypertension, previous renal failure, or New York Heart Association class), number of emergency cases, or graft ischemia time. Mean IFoM was 114.3 months (range = 5.3–350.4). After heart transplantation, there were no significant differences between the number of infections (47.9%; n = [279] vs 33.3% n = 4; P = .39), rejection episodes (44.4% [259] vs 50% [6], P = 0.77) or post-HT malignancies (12.2% [70] vs 0%, P = 0.37) between the overall series and the patients with PTM. None of the patients with PTM suffered a recurrence of the neoplasm. Actuarial survivals at 1, 3, and 5 years were 82%, 76%, and 70% among patients without PTM and 75%, 75%, and 56% among those with PTM ( P = .70). Conclusion Patients with PTM and an appropiate IFoM with regard to tumor lineage showed similar rates of survival and complications as those of the overall series. This series suggested that appropriately selected patients with a cured PTM can be candidates for HT.

Effect of donor-recipient age difference on graft function and survival in live-donor kidney transplantation

Renal transplant recipients of older deceased-donor kidneys have reduced allograft survival. However, the impact of donor-recipient age difference on live-donor kidney transplant outcomes, where donors are older than recipients, remains unclear. Using the Australia and New Zealand Dialysis and Transplant Registry, all primary live-donor kidney transplant recipients in Australia from 1991 to 2006 were studied. Donor-recipient age difference was divided into four categories (donor-recipient<-10, -10-20, 20-29 and ≥30 years). Outcome measures included serum creatinine, graft and patient survival. In the adjusted model, donor-recipient age difference of ≥30 years showed a trend towards increased risk of graft failure compared with a difference of -10-20 years during the first year post-transplant only (hazard ratio=2.11, 95% CI=1.00-4.47; P=0.05). However, in the multivariate competing risks Cox model, donor-recipient age difference was not associated with increased patient death, death-censored graft failure or serum creatinine at 5 or 10 years, nor was it associated with increased risk of acute rejection within the first 6 months. Recipients of kidney transplants donated by live donors who are significantly older than recipients have similar graft and patient survivals to recipients from organs of similar vintage. Thus, living kidney donors, who are up to 30 years older than their recipients, provide kidneys of excellent quality. These findings are of relevance when considering paired kidney donation programme because the chance of finding a suitable match should not be unnecessarily limited by unjustified restrictions on the perceived disadvantage of high donor-recipient age difference.

Donor‐specific transfusions

Date written: June 2007Final submission: October 2008