By Charles Bankhead, Staff Writer, MedPage Today
Published: November 08, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
SAN FRANCISCO -- Donor age did not affect recipient survival after liver transplantation over the past five years, data from a single-center experience showed.
Recipients of older donor livers had a one-year survival of 88% and a three-year survival of 69%, which did not differ from the overall transplant-recipient population at the center during the same time period.
In contrast, patients who received older donor livers prior to 2006 had a significantly worse survival compared with the overall transplant population.
The improved survival with older liver grafts reflected improved screening of potential transplant candidates, according to a report here at the American Association for the Study of Liver Diseases meeting.
"Although series have shown increased risk with elderly donor livers, our experience suggests this risk dissipates as a center progresses along its learning curve," Jonah Zaretsky, BS, of Columbia University in New York, and colleagues concluded in a poster presentation.
"With increased experience, elderly donors have been an excellent source of livers. We have shown that these livers are optimally used in nonhepatitis C patients."
The ongoing imbalance between candidates for liver transplantation and the donor pool has increased interest in extended criteria for potential donors. Over the past decade, extended-criteria donors have accounted for a third of all liver transplants at Columbia, Zaretsky reported.
Older donors constitute a sizable proportion of extended-criteria liver grafts, and the fraction could increase in the future, given current demographic trends. As a result, identification of older-donor characteristics that could influence transplant outcome has become increasingly relevant.
Zaretsky and colleagues retrospectively reviewed their experience with liver transplants involving older donors from December 1998 to March 2010, with follow-up to April 2011. They identified 105 liver transplants involving donors ages 70 and older from a total transplant volume of 987 adult procedures.
Using 2006 as the cutoff for early and recent clinical experience, the investigators found that 48 (46%) patients received an older-donor liver from 1998 to 2005 and 57 patients (54%) received an older-donor liver during the more recent experience.
A comparison of donor and recipient characteristics for the two time periods showed that the recent cohort of recipients was slightly older (58 versus 55, P=0.057), significantly healthier by MELD score (15 versus 24, P less then 0.001), and significantly less likely to have hepatitis C virus (HCV) infection (7% versus 50%, P less then 0.001). The proportion of recipients with hepatocellular carcinoma did not change significantly (42% versus 50%, P=0.419).
The average age of donors increased slightly in the more recent experience (77 versus 75, P=0.072).
Overall survival for all transplanted patients was identical during the two periods: 87% at one year and 76% at three years. Survival in the subgroup of patients who received older-donor livers was significantly lower during 1998 to 2005 (73% at one year, 56% at three years,
P less then 0.001) but not among patients transplanted from 2006 to 2010.
Graft survival improved significantly over time, as the later cohort had a one-year graft survival of 88% versus 67%, and a three-year graft survival 69% versus 50% (P=0.021).
Analysis of one-year graft survival per every 10 transplant procedures involving older donors showed a dramatic improvement from 60% during procedures 31 through 40 and 41 through 50 to 100% for procedures 51 through 60 and 61 through 70.
The improved graft survival occurred in concert with a decline in the proportion of HCV-positive recipients, from 60% during procedures 21 to 30 to 10% of procedures 51 through 60 and 0% of procedures 61 through 70, 81 through 90, and 91 through 100.
Multivariate analysis identified recipient diagnosis of HCV as the only significant predictor of outcome. Transplantation after 2006, recipient diagnosis of hepatocellular carcinoma, recipient age greater than 65, and MELD score greater than 25 did not affect outcome.
Zaretsky had no relevant disclosures. Co-investigators disclosed relationships with Cangene, Gilead, Merck, Vertex, Genentech, Novartis, Salix, Tibotec, Vertex, and GlobeImmune.
Primary source: American Association for the Study of Liver DiseasesSource reference:Zaretsky JS, et al "Optimizing outcomes of 105 liver transplants using elderly donors over 70: Improvements along the learning curve" AASLD 2011; Abstract 641.
http://www.medpagetoday.com/MeetingCoverage/AASLD/29535
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