Use Of Elderly Donors Research Articles

Expected Life Expectancy on Liver Transplantation and Aging Donor.

In this study, our aim was to show the life expectancy according to donor age groups at 1, 3, 5, 10, 15, and 20 years after liver transplant in liver transplant recipients. In this retrospective study, we analyzed the survival rate of 236 patients who had liver transplant procedures between 1988 and 2021. The 5-year life expectancy of recipients with donors over age 50 years in the literature has been shown to vary between 50% and 80%. Little information could be found on life expectancy after 10, 15, and 20 years in other studies. In the studies from Haberal and colleagues, life expectancy at 10, 15, and 20 years was 49%, 42%, and 42%, respectively. This study presents an evidence-based example of the use of elderly donors to enlarge the donor pool.

Age and liver graft: a systematic review with meta-regression

Increasing organ shortage results in extended criteria donors (ECD) being used to face the growing demand for liver grafts. The demographic change leads to greater use of elderly donors for liver transplantation, historically considered marginal donors. Age is still considered amongst ECD in liver transplantation as it could affect transplant outcomes. However, what is the cutoff for donor age is still unclear and debated. A search of PubMed, Scopus and Cochrane Library was performed. The primary outcome was 1-year graft survival (GS). The secondary outcome was overall biliary complications and 3–5 years of graft and overall survival. A meta-regression model was used to analyse the temporal trend relation in the survival outcome. The meta-analysis included 11 studies. Hazard ratios for 1-year (age cutoff of 70 and 80,) and 5-year GS (I2:0%) were similar irrespectively of the age group. The meta-regression analysis showed a significant correlation between the 1-year graft survival and the year of publication. (coef. 0.00027, 95% CI − 0.0001 to − 0.0003 p = 0.0009). Advanced-age donors showed an increased risk of overall biliary complications with an odd ratio (OR) of 1.89 (95% CI 1–3.65). Liver grafts potentially discharged because of high-risk failure show encouraging results, and GS in ECD has progressively improved with a temporal trend. Currently, the criteria of marginality vary amongst centres. Age alone cannot be considered amongst the extended criteria. First of all, because of the positive results in terms of septuagenarian graft survival. Moreover, the potential elderly donor-related adjunctive risk can be balanced by reducing other risk factors. A prospective multicentre study should investigate a multi-factorial model based on donor criteria, recipient features and new functional biomarkers to predict graft outcome, as proper donor–recipient matching seems to be the critical point for good outcomes.

Analysis of Heart Transplant Survival According to Difference in Age Between Donor and Recipient

The age of heart transplant (HTx) donors and recipients is progressively increasing. The combination of donor-recipient ages has been shown to have prognostic implications. The objective of this study is to analyze survival in the first year and in the long-term based on the difference in age between donor and recipient of HTx. We performed a retrospective analysis of all consecutive HTxs performed in 1 center from 1987 to December 2021. Patients younger than 16 years, retransplants, and combined transplants were excluded. Three groups were considered according to the age of the donor and recipient: group 1: recipient and donor of the same age ± 10 years; group 2: donor >10 years older than recipient; and group 3: donor >10 years younger than recipient. A total of 841 HTxs were included (81% men, 31% urgent HTxs, donor mean (standard deviation) age 38.5 [12.3] years and recipient age 51.2 [12]). The most frequent group was group 3 with 476 patients (56%) followed by group 1 with 305 patients (36%). Figure 1 shows that long-term survival is similar in groups 1 and 2, being worse in group 3, P=.026. Mortality at the end of follow-up is 38.7% in group 1, 34.9% in group 2, and 71.9% in group 3 (P < .0001). These differences occurred in the long-term without finding significant differences the first year after HTx. No differences were found in early graft failure between the 3 groups. Using donors of a different age from the recipient does not seem to have an impact on long-term survival, except when donors are used who are more than 10 years younger than the recipient, where survival is lower. This consolidates the concept that the use of elderly donors does not affect survival, allowing the pool of donors to be expanded.

Outcomes of deceased donor liver transplantation from elderly donors

Favorable outcomes achieved after deceased donor liver transplantation (DDLT) suggest that use of elderly donors may be an effective way to expand donor pool. This was a retrospective analysis of adult DDLT using elderly donors. It was a double-arm study that compared posttransplant outcomes to ascertain whether use of elderly donors (aged ≥76 years) has adverse effects on outcome of DDLT. The elderly study group included 14 donors aged ≥76 years and the elderly control group comprised 39 donors aged 66-75 years. Mean age of the elderly and control groups was 78.2 ± 3.1 years and 68.9 ± 2.7 years, respectively (p < 0.001). Other clinical parameters were comparable between these two groups. The 1-, 3-, and 5-year graft survival rates in the elderly study group were 83.6%, 59.7%, and 59.7%, respectively, and those in the elderly control group were 79.4%, 68.1%, and 59.6%, respectively (p = 0.97). The overall 1-, 3-, and 5-year survival rates after donation from the elderly study group were 83.6%, 59.7%, and 59.7%, respectively, and those after donation from the control group were 79.3%, 72.1%, and 64.1%, respectively (p = 0.74). Regarding overall patient survival, univariate analysis identified pretransplant requirement for ventilator support (p = 0.021) and pretransplant renal replacement therapy (p = 0.025) as statistically significant risk factors; however, neither was significant on multivariate analysis. The data suggest that organs from elderly donors do not worsen posttransplant outcomes; thus, advanced age should not be an exclusion criteria criterion. Indeed, using such donors could be the key to increasing the supply of liver grafts.

Outcomes of deceased donor liver transplantation from elderly donors.

BackgroundFavorable outcomes achieved after deceased donor liver transplantation (DDLT) suggest that use of elderly donors may be an effective way to expand donor pool.MethodsThis was a retrospective analysis of adult DDLT using elderly donors. It was a double-arm study that compared posttransplant outcomes to ascertain whether use of elderly donors (aged ≥76 years) has adverse effects on outcome of DDLT. Elderly donor study group included 14 donors aged ≥76 years and elderly donor control group comprised 39 donors aged 66–75 years.ResultsMean donor age of the study and control groups was 78.2±3.1 years and 68.9±2.7 years, respectively (P<0.001). Other clinical parameters were comparable between these two donor groups. The 1-, 3-, and 5-year graft survival rates in the elderly study group were 83.6%, 59.7%, and 59.7%, respectively, and those in the elderly control group were 79.4%, 68.1%, and 59.6%, respectively (P=0.97). The overall 1-, 3-, and 5-year survival rates after donation from elderly study group were 83.6%, 59.7%, and 59.7%, respectively, and those after donation from control group were 79.3%, 72.1%, and 64.1%, respectively (P=0.74). Regarding overall patient survival, univariate analysis identified pretransplant requirement for ventilator support (P=0.021) and pretransplant renal replacement therapy (P=0.025) as statistically significant risk factors; however, neither was significant on multivariate analysis.ConclusionsThe results of this study suggest that using an elderly donor graft might not worsen the posttransplant outcomes significantly; thus, advanced age per se may not be an exclusion criterion for organ donation.

Impact of the elderly donor on an abdominal organ transplantation program

Older donors have become widespread in recent years. Given that they have comorbidities, the treatment of theses donors is crucial. Our aim was to analyze the influence of the elderly donor (≥65 years) on the subsequent evolution of liver and kidney recipients. Retrospective study including all liver and kidney transplants performed at the Marques de Valdecilla University Hospital with grafts generated from local donors in brain death. Period: 2014–2017. Two groups were considered, depending on the age of the donor (≥ or <65 years). There were 37 older donors (from 100 donors in brain death). Fourteen liver transplants were performed with old grafts that were characterized by a lower Model for End-stage Liver Disease (MELD) score (13.5 [interquartile range (IQR): 10–14] vs. 19 [IQR: 16–22], p: 0.004). The values of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were higher over time in the older graft recipients. 18 renal transplants were performed with grafts from older donors. This group were older (62 vs. 57, p: 0.001) and had longer hospital stay (25 vs. 17 days; p: 0.023). There were no significant differences in the development of primary graft disfunction or graft loss. Liver transplant survival and kidney survival were similar in both groups. The use of elderly donors has not influenced the clinical evolution of liver and kidney transplants in our series. Older donors should no longer be considered suboptimal, because they offer a possibility for certain patients on the waiting list.

Survival Outcomes in Liver Transplantation With Elderly Donors: Analysis of Andalusian Transplant Register

Recently, there has been a large discrepancy between the number of patients on the waiting list for a liver transplant and the availability of deceased donors, with an increase in annual wait list mortality rates. Elderly donor livers are thought to be marginal grafts; however, in recent years, their utilization has constantly increased. The aim of this study is to evaluate the utilization of elderly donors in Andalusia and post-transplant outcomes. This retrospective observational study of 2408 liver transplants, performed in Andalusia between 2000 and 2014, analyzes the outcomes from donors aged 70 plus (n = 423) in terms of survival rates of the graft and the recipient, the type of transplant, donor age, and D-MELD score (product of donor age and preoperative Model for End-stage Liver Disease score). The most frequent indications for transplant were alcoholic cirrhosis (49.2%), hepatitis C cirrhosis (13%), and hepatocellular carcinoma (12.5%). The overall survival at 5 years was 64%, with a significant fall in survival for recipients with a D-MELD greater than 1500 (57%; P = .045). In the 70-year-old-plus donor group, the overall patient survival was 58.4%. The retransplant rate increased proportionately with donor age. In the alcoholic cirrhosis recipient subgroup, the overall survival at 5 years was 67.6% (P < .05) compared with 33.5% in patients with hepatitis C. Use of elderly donors is a safe strategy to reduce the scarcity of donors, provided that a D-MELD score below 1500 is obtained. Retransplant rates increase progressively with donor age. It is necessary to carefully screen recipients of older organs, taking into account that the best results are obtained for alcoholic cirrhosis, negative viral load hepatitis C, and a D-MELD score below 1500.

Use of Elderly Allografts in Liver Transplantation.

The use of liver allografts from elderly donors (≥70 years) has increased because of organ shortage and increased life expectancy. The aim of this study is to evaluate the current utilization of elderly donors in United States, recipient selection, and their posttransplant outcomes. A linkage between Scientific Registry of Transplant Recipients and University HealthSystem Consortium databases was performed. Between January 2007 and December 2011, 12,445 liver transplant (LT) recipients were identified and divided into 2 cohorts based on donor age: 70 years or older (n = 540) and younger than 60 years (n = 10,473). Elderly donors accounted for 4.3% of all donors used in the 5-year period. When compared to younger donors, elderly donors were more likely to be women, shared regionally or nationally, and used at higher volume centers. Elderly donor allografts were less likely to be used in recipients with model of end-stage liver disease score higher than 27 (13.2% vs. 23.0%, P < 0.001), hospitalized (16.8% vs. 21.7%, P = 0.03), or on hemodialysis at time of transplant (2.6% vs. 8.2%, P < 0.001). Both recipient groups had similar perioperative mortality, 30-day readmission rates, and short-term patient survival. In the multivariate analysis, including recipient, donor, center and regional factors, donor age 70 years or older was associated with slightly increased risk of graft loss (hazard ratio, 1.3; 95% confidence interval, 1.08-1.56; P = 0.005). The current trend toward the use of elderly donors in liver transplant recipients with low model of end-stage liver disease scores (<27), without hepatitis C, not hospitalized and not on dialysis, is associated with acceptable perioperative outcomes, patient survival, and slightly worse graft survival.

Effect of Donor–Recipient Age Matching in Living Donor Liver Transplantation

BackgroundThe use of a marginal donor, such as an elderly donor, in liver transplantation has been increasing in response to organ disparity; however, major risk factors for graft and patient survivals have been reported. MethodsWe retrospectively reviewed the medical records of 559 patients who underwent living-donor liver transplantation (LDLT) at our hospital from May 2003 to June 2013. Elderly donors were defined as those >50 years old, and elderly recipients were defined as those >60 years old. We evaluated the differences in survival according to donor and recipient ages. Furthermore, we compared post-transplantation outcomes according to donor-recipient age matching. ResultsThe overall 5-year survival rate of the recipients was significantly lower in the elderly donor group than in the younger donor group (84.6% vs 58.2%; P < .001). However, no significant difference in survival rate was observed according to recipient age (P = .908). The survival rate of elderly recipients who received a graft from an elderly donor was significantly lower than those of the other groups (P < .001–.037). The mortality rate was significantly different among the groups (P < .001), and among the causes of death, surgical complications were most frequent cause in the elderly donor group (P < .001). ConclusionsLDLT with the use of elderly donors >50 years of age could result in higher mortality rates than using younger donors. As such, elderly donor livers ideally should be matched with young recipients and attention concentrated on the surgical complications.

Long-Term Outcomes of Kidney Transplantation from Elderly Donors

Summary Introduction. During the last years the percentage of elderly organ donors has increased significantly and may impact results of kidney transpalantations (KT). Aim of the Study. Was to analyse results of kidney transplantation from elderly donors. Materials and methods. In this study we analysed results of all consecutive KT from deceased donors (DD) performed in a single transplantation center during the period from 01.01.2004 till 31.12.2007, with the following exclusion criteria: unavailability of 5-year follow-up and transplantation from DD aged from 50 to 59 years. In result the study population consisted of 193 KT recipients, and all cases were divided into two groups according to donor age: group A (donor age &gt;60 years, 27 KT from 18 DD, mean age of donors 62,6 + 2,1 years, mean age of recipients 58,0 + 9,0 years), and group B (donor age &lt;49 years, 166 KT from 98 DD, mean age of donors 35,4 + 10,2 years, mean age of recipients 40,5 + 14,7 years). Groups were compared for posttransplant outcomes and 5-year graft and patient survival. Results. During the study period the number of transplantations from donors aged &gt;60 years amounted to 10.5% of all transplantations. The use of elderly donors was not associated with worse early posttrransplant results; in long-term it was associated with higher patient mortality and lower rate of death-censored graft losses, however analysis of survival revealed difference only in patient 5-year survival (p=0.001). Conclusion. KT from older donors when allocated to age-matched recipients ensures acceptable outcomes and should be continued in the future with recommendation to keep cold ischemia time as short as possible and to introduce urgent analysis of donor kidney “zero” biospy.

Use of Elderly Allografts in Liver Transplantation.

Purpose: Use of liver allografts from elderly donors has increased due to organ shortage and increased life expectancy of the general population. The aim of this study is to evaluate the current utilization of elderly donors in the United States, patterns of recipient selection, and their outcomes. Methods: Using a linkage between the Scientific Registry of Transplant Recipients and University HealthSystem Consortium databases, we identified 12,445 liver transplant (LT) recipients between January 2007 and December 2011. Recipients were divided into two cohorts based on the donor age: ≥ 70 years (n= 540) and < 60 years (n= 10,473). A stepwise cox regression evaluated the impact of elderly donors on graft survival after adjusting for transplant related factors. Results: Elderly donors accounted for 4.3% of donors used in the five-year period. Compared to younger donors, elderly donors were more likely to be females (53.9% vs. 39.0%, P<0.001), shared regionally or nationally (46.4% vs. 28.5%, P<0.001), and used at high volume centers (48.5% vs. 32.2%, P<0.001). The top three centers using elderly donors accounted for 1/3 of all elderly donors, and resided in Regions 7 and 9. The comparison between the two recipient cohorts showed that recipients of elderly donors were older (> 60 years: 47.8% vs. 29.1%, P<0.001), less likely to be on dialysis (2.6% vs. 8.1%, P<0.001), or inpatient at time of LT (16.9% vs. 21.7%, P=0.03), and had lower MELD score (>28: 13.2% vs. 23.0%, P<0.001). Both recipient groups had similar perioperative mortality, readmission rates, and long-term patient survival. Recipients of elderly donors were associated with increased graft loss (p<0.001). In the multivariate analysis, elderly donors were associated with increased risk of graft failure only when adjusted for recipient characteristics (HR 1.32, 95% CI 1.11-1.56) or center and regional factors (HR 1.23; 95% CI 1.04-1.46) individually; however, in the adjusted analysis including all these factors together, elderly donors did not carry increased risk of graft failure. Conclusions: Currently, the use of elderly liver allografts is limited to selected recipients (older age, less severe disease) by high volume centers in regions of high wait list mortality. Adjusted analysis of graft survival confirms that the use of elderly donors in appropriately selected recipients and centers results in acceptable graft survival.

Q-FISH measurement of hepatocyte telomere lengths in donor liver and graft after pediatric living-donor liver transplantation: donor age affects telomere length sustainability.

Along with the increasing need for living-donor liver transplantation (LDLT), the issue of organ shortage has become a serious problem. Therefore, the use of organs from elderly donors has been increasing. While the short-term results of LDLT have greatly improved, problems affecting the long-term outcome of transplant patients remain unsolved. Furthermore, since contradictory data have been reported with regard to the relationship between donor age and LT/LDLT outcome, the question of whether the use of elderly donors influences the long-term outcome of a graft after LT/LDLT remains unsettled. To address whether hepatocyte telomere length reflects the outcome of LDLT, we analyzed the telomere lengths of hepatocytes in informative biopsy samples from 12 paired donors and recipients (grafts) of pediatric LDLT more than 5 years after adult-to-child LDLT because of primary biliary atresia, using quantitative fluorescence in situ hybridization (Q-FISH). The telomere lengths in the paired samples showed a robust relationship between the donor and grafted hepatocytes (r = 0.765, p = 0.0038), demonstrating the feasibility of our Q-FISH method for cell-specific evaluation. While 8 pairs showed no significant difference between the telomere lengths for the donor and the recipient, the other 4 pairs showed significantly shorter telomeres in the recipient than in the donor. Multiple regression analysis revealed that the donors in the latter group were older than those in the former (p = 0.001). Despite the small number of subjects, this pilot study indicates that donor age is a crucial factor affecting telomere length sustainability in hepatocytes after pediatric LDLT, and that the telomeres in grafted livers may be elongated somewhat longer when the grafts are immunologically well controlled.

Utilization of elderly donors in living donor liver transplantation: When more is less?

An accepted definition of donor exclusion criteria has not been established for living donor liver transplantation (LDLT). The use of elderly donors to expand the living donor pool raises ethical concerns about donor safety. The aims of this study were (1) the comparison of the postoperative outcomes of living liver donors by age (≥ 50 versus < 50 years) and (2) the evaluation of the impact of the extent of right hepatectomy on donor outcomes. The study group included 150 donors who underwent donor right hepatectomy between October 2004 and April 2009. Extended criteria surgery (ECS) was defined as right hepatectomy with middle hepatic vein (MHV) harvesting or right hepatectomy resulting in an estimated remnant liver volume (RLV) less than 35%. The primary endpoints were donor outcomes in terms of donor complications graded according to the Clavien classification. Group 1 consisted of donors who were 50 years old or older (n = 28), and group 2 consisted of donors who were less than 50 years old (n = 122). At least 1 ECS criterion was present in 74% of donors: 57% had 1 criterion, and 17% had 2 criteria. None of the donors had grade 4 complications or died. The overall and major complication rates were similar in the 2 donor age groups [28.6% and 14.3% in group 1 and 32% and 8.2% in group 2 for the overall complication rates (P = 0.8) and the major complication rates (P = 0.2), respectively]. However, there was a significant correlation between the rate of major complications and the type of surgery in donors who were 50 years old or older. In LDLT, extending the limits of surgery comes at the price of more complications in elderly donors. Right hepatectomy with MHV harvesting and any procedure causing an RLV less than 35% should be avoided in living liver donors who are 50 years old or older.

Results of Liver Transplantation from Donors Over 75 Years: Case Control Study

Introduction The use of elderly donors can increase the pool of organs available for transplant. The aim of this study was to analyze the outcomes of grafts from donors older than 75 years. Patients and methods We selected 29 patients transplanted from January 2003 to January 2010 with livers from donors older than 75 years for comparison with a control group (58 patients), selected among patients transplanted immediately before or after each study case. Data analyzed using SPSS 15.0 were considered statistically significant at P < .05. Results Statistically significant differences were evident in the mean age of donors (78.3 ± 2.9 vs 50.4 ± 17.8 years, P < .001), levels of aspartate aminotransferase alanine aminotransferase (30.8 ± 18.13/24.9 ± 14.4 vs 53.81 ± 68.4/39.37 ± 39.94 U/L, P < .05), and waiting list time of (122.4 ± 94.3 vs 169.2 ± 135.5 days, P = .034) of elderly donor versus control graft cohorts. The median follow-up was 32 months (range: 4–88.0) No differences were observed at 1 and 3 years after transplantation: graft survival was 78% and 61% in the older donor group and 83% and 71% in the younger donor group, respectively. Conclusion The use of expanded donors from elderly subjects can increase the donor pool with good results.

Improving the Waiting List by Using 75-Year-Old Donors for Recipients With Hepatocellular Carcinoma

The best treatment for hepatocellular carcinoma (HCC) associated with liver cirrhosis is liver transplantation and the best results are obtained when the tumors fulfill the Milan criteria. However, although the number of transplants is increasing, the organ deficit is growing, which lengthens time on the waiting list, increasing the risk of tumor progression of and exclusion from the list. The use of elderly donors is a valid option for patients on the transplant waiting list with HCC, reducing time on the waiting list. We report our experience with patients transplanted for HCC associated with hepatic cirrhosis using livers from donors >75 years of age. Our preliminary results supported the use of elderly suboptimal donors making it possible to give priority to these patients. All patients in the series achieved good graft function after a follow-up of 2 years with a 100% disease-free survival rate. More extensive long-term studies are needed to confirm these findings.

Quality and Safety in the Italian Donor Evaluation Process

The shortage of available organs, has increasingly prompted the use of elderly donors, with a consequent growth of possible risk factors. In this context the risk of donor-recipient transmission of infectious or neoplastic pathologies may be considered as a major issue; in each case for each organ potentially available, acceptable quality must be provided and unacceptable risks must be avoided. We are presenting here the process of risk management followed by the Italian centers. In 2001, the Italian National Transplant Centre created a national commission of experts, with the mission of defining guidelines for the evaluation process of the potential organ donor. As a supplement to these measures, the Italian National Transplant Centre has supported transplant network health workers through ad hoc developed information tools and an expert task force (second opinion) for evaluation of doubtful cases. Starting from the date of guidelines application and second opinion start up, 9519 potential cadaveric donors were reported in Italy. Of these, 1611 presented a neoplastic or infectious risk. Over this period, 4861 donors were used for transplantation, equal to 48.5% of reported donors. Among the 1611 donors, who had been diagnosed at risk, 674 were neoplastic-disease affected donors and 937 infection-disease affected donors. At the European level, several new activities have been recently implemented to increase organ safety. In Italy, new guidelines and actions to ensure organ safety have been implemented. The evaluation of the impact of these actions will be performed in the near future.

Use of Marginal Donors in Kidney Transplantation: Our Experience

The use of elderly donors has been advocated to expand the organ donor pool because of increased needs and the organ shortage. The aim of this study was to analyze whether the use of elderly donors and marginal kidneys affected the outcome of renal transplantations. Herein we presented data on 126 kidney transplantations performed from January 1996 to September 2003 using 32 marginal donors (group A) and 94 ideal donors (group B). We analyzed the medical and surgical complications and the graft survivals at a median follow-up of 18 months. Medical and surgical complications occurred in 22% and 5% versus 7% and 4% in groups A and B, respectively. The mean cold ischemia time and the mean age were greater for patients undergoing kidney transplantations from marginal donors. No differences were observed in graft survival in groups A and B. In conclusion, our data suggested that with an appropriate strategy and a correct selection of patients, marginal kidneys can be safely used to decrease the gap between demand and supply.

Improving Results of Renal Transplantation With the Use of Elderly Donors: The Budapest Experience

The use of elderly donors has become a necessity with the increasing demand for deceased donor organs resulting in transplant centers worldwide expanding their donor criteria. We, therefore, thought it appropriate to review our experience using elderly (>60 years) brain-dead donors for kidney transplantation. We investigated the influence of donor parameters on early graft function and survival. A retrospective comparative analysis of three periods was performed: 1994 to 1998 (P1) n = 40; 1999 to 2000 (P2) n = 28; and 2001 to 2002 (P3) with n = 31 donors. Mean donor age in each period was 63.4 ± 3.3, 64.5 ± 3.4, and 63.8 ± 2.7 years; mean diuresis was 473 ± 450, 307 ± 316, and 276 ± 185 mL/hour; and the need for vasopressors during donor management was 81%, 85%, and 70% respectively. The number of kidney recipients was 59, 30, and 37, mean age was 49 ± 13, 53 ± 11 and 54 ± 8 years, the recipient ratio of patients >60 years was 17%, 33%, and 27% respectively, and no differences among the groups in the HLA mismatch. Primary nonfunction occurred in 8.5%, 0%, and 2.8%; acute rejection ratio at 1 year was 35%, 36%, and 32%, the mean serum creatinine at 12 months was 183.7 ± 66.0, 157.8 ± 41.2 and 160.7 ± 46.5 μmol/L. The 1-year graft survival was 71.2%, 91.0% and 92.0% and the 1-year patient survival 88.2%, 96.6%, and 97.2%, respectively, for periods 1, 2, and 3. There has been a considerable improvement in the 1-year graft and patient survivals. With careful donor and recipient evaluation, individualized immunosuppression, and age matching the results of renal transplantation from elderly deceased donors can be comparable to the results of the “optimal” deceased donor kidney transplantation.

Causes of early acute graft failure after liver transplantation: analysis of a 17‐year single‐centre experience

Despite satisfactory overall results reported, early post-operative period after liver transplantation (LT) still represents a critical time with persistently high rate of graft loss. We retrospectively reviewed our experience of 17 yr in LT, analysing the impact on grafts and patient survivals of the acute complications affecting the graft in the early period following LT. To evaluate the changes that occurred over the years in case of early acute graft failure (EAGF), the study population was divided into three equal groups of 223 patients corresponding to three different periods. Ninety (13.5%) experienced an EAGF. Causes of EAGF were hepatic artery thrombosis (HAT) in 32 cases (4.8%), primary graft non-function in 29 cases (4.3%), caval stenosis in 19 (2.8%), early irreversible acute rejection in 6 (0.9%) and portal vein thrombosis in 4 (0.6%). The use of elderly donors and the introduction of the piggyback technique proved to be associated with a higher incidence of HAT and caval stenosis, respectively. Female recipients of male donors were independently associated with Primary graft non-function. Of 90 patients with EAGF, 20 (22.2%) died within the first month after LT, 34 (37.8%) underwent retransplantation (ReLT) and 36 (40%) received conservative treatment. Conservative treatments increased from 3.6% in the first group to 47.0 and 66.8% in the second and third one (p = 0.000). One-year graft and patient survival of patients with EAGF significantly improved over the three eras analysed. The incidence of EAGF remains consistent. Nevertheless, a better understanding of the clinical situations and changes in treatment strategies have led to significant improvements in terms of graft and patient survival rates, now close to the survival rate of EAGF-free patients.

The impact of donor age on the results of renal transplantation.

The use of elderly donors is becoming more frequent. An increase in the donor's age is associated with a greater incidence of delayed graft function (DGF), chronic allograft nephropathy (CAN) and worse graft survival. Poor renal graft function is a risk factor for cardiovascular (CV) complications and, finally, for mortality of the patients. A total of 3365 adult patients transplanted in 1990 (n = 824), 1994 (n = 1075) and 1998 (n = 1466) with a functioning graft after the first year were included. The impact of donor age on renal function, DGF, acute rejection and other clinical factors was evaluated according to two donor and recipient age categories: young (< 60 years old) and elderly (> or =60 years old). Additionally, donor age was categorized by decades for the analysis of patient and graft survival, acute rejection and CV mortality. Donor mean age significantly increased during the three transplantation periods. A total of 478 out of 3365 donors were older than 60 years. Elderly donors showed an increased risk of DGF (38.9 vs 28.8%) and CAN (56.8 vs 46.2%). Mean serum creatinine at 3 and 12 months and proteinuria were significantly higher in the old donor group. Incidence and severity of acute rejection were similar in both groups. Graft and patient survival were significantly lower in the old donor group. Also, risk of mortality due to CV events was also significantly higher. A linear increase in risk of graft loss, patient death or CV mortality was observed when donor age was divided into 10 year increase subsets. Donor age is a strong predictor of CAN and graft loss. Patient survival is also affected by donor age, particularly by a higher risk of CV mortality.