Risk analysis of ischemic-type biliary lesions after liver transplant using octogenarian donors

Liver Transpl. 2016 May;22(5):588-98. doi: 10.1002/lt.24401.

Abstract

The use of octogenarian donors to increase the donor pool in liver transplantation (LT) is controversial because advanced donor age is associated with a higher risk of ischemic-type biliary lesions (ITBL). The aim of this study was to investigate retrospectively the role of a number of different pre-LT risk factors for ITBL in a selected population of recipients of octogenarian donor grafts. Between January 2003 and December 2013, 123 patients underwent transplantation at our institution with deceased donor grafts from donors of age ≥80 years. Patients were divided into 2 groups based on the presence of ITBL in the posttransplant course. Exclusion criteria were retransplantations, presence of vascular complications, and no availability of procurement liver biopsy. A total of 88 primary LTs were included, 73 (83.0%) with no posttransplant ITBLs and 15 (17.0%) with ITBLs. The median follow-up after LT was 2.1 years (range, 0.7-5.4 years). At multivariate analysis, donor hemodynamic instability (hazard ratio [HR], 7.6; P = 0.005), donor diabetes mellitus (HR, 9.5; P = 0.009), and donor age-Model for End-Stage Liver Disease (HR, 1.0; P = 0.04) were risk factors for ITBL. Transplantation of liver grafts from donors of age ≥80 years is associated with a higher risk for ITBL. However, favorable results can be achieved with accurate donor selection. Donor hemodynamic instability, a donor history of diabetes mellitus, and allocation to higher Model for End-Stage Liver Disease score recipient all increase the risk of ITBL and are associated with worse graft survival when octogenarian donors are used. Liver Transplantation 22 588-598 2016 AASLD.

MeSH terms

  • Aged, 80 and over
  • Algorithms
  • Biliary Tract / injuries*
  • Biliary Tract / pathology
  • End Stage Liver Disease / surgery
  • Female
  • Graft Survival
  • Hemodynamics
  • Humans
  • Liver Transplantation / adverse effects*
  • Male
  • Proportional Hazards Models
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment / methods*
  • Severity of Illness Index
  • Time Factors
  • Tissue Donors*
  • Treatment Outcome