Donor age and outcome of liver transplantation

Jay H. Hoofnagle, Manuel Lombardero, Rowen K Zetterman, John Lake, Michael Porayko, James Everhart, Steven H. Belle, Katherine M. Detre, Yuling Wei

Research output: Contribution to journalArticle

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Abstract

To evaluate the effect of donor age on graft and patient outcome after liver transplantation an analysis of a large-scale cohort study was performed at three tertiary referral liver transplant centers. Between April 1990 and June 1994, 772 adults underwent an initial single-organ liver transplantion. The age of the donors averaged 35 years; 193 (25%) were 50 or above, the age used to define 'older' donors. Groups were compared for demographic, clinical, and biochemical features. Outcome was measured using results of biochemical tests after transplantation and by graft and patient survival. Compared with younger donors, older donors were more commonly women (59% vs. 33%: P ≤ .001) and died of central nervous system causes (79% vs. 28%) as opposed to trauma (13% vs. 63%: P ≤ .001). The recipients of the two groups of donor livers did not differ in important respects. However, intraoperatively, livers from older donors were more likely to be assessed as either 'poor' or 'fair' as opposed to 'good' (17% vs. 4%: P ≤ .001) by the harvesting surgeon and to have initial 'poor' or 'fair' bile production (29% vs. 18%: P ≤ .001). During the first week postoperatively, the serum aminotransferase and bilirubin levels and prothrombin times were higher in recipients of older than those of younger donor livers. During followup, graft survival was less for recipients of older donor livers at 3 months (81% vs. 91%: P = .0001) and at 1 (76% vs. 85%: P = .007) and 2 years (71% vs. 80%: P = .005); patient survival showed similar though less marked differences. This association of donor age and poorer graft survival persisted after adjusting for many variables using bivariate and multivariate analyses. Importantly, however, the association with poor graft survival was largely among recipients of older donor livers, the quality of which was assessed as fair or poor by the harvesting surgeon; recipients of older donor livers assessed as good had a retransplant-free survival similar to that of younger donor livers (87% vs. 91% at 3 months). Thus, use of older donor livers, the quality of which are judged to be good by the harvesting surgeon, is not associated with a decrease in patient or graft survival after liver transplantation.

Original languageEnglish (US)
Pages (from-to)89-96
Number of pages8
JournalHepatology
Volume24
Issue number1
DOIs
StatePublished - Jan 1 1996

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Liver Transplantation
Tissue Donors
Liver
Graft Survival
Transplants
Survival
Prothrombin Time
Transaminases
Bilirubin
Bile
Cohort Studies
Referral and Consultation
Multivariate Analysis
Central Nervous System
Transplantation
Demography

ASJC Scopus subject areas

  • Hepatology

Cite this

Hoofnagle, J. H., Lombardero, M., Zetterman, R. K., Lake, J., Porayko, M., Everhart, J., ... Wei, Y. (1996). Donor age and outcome of liver transplantation. Hepatology, 24(1), 89-96. https://doi.org/10.1053/jhep.1996.v24.pm0008707288

Donor age and outcome of liver transplantation. / Hoofnagle, Jay H.; Lombardero, Manuel; Zetterman, Rowen K; Lake, John; Porayko, Michael; Everhart, James; Belle, Steven H.; Detre, Katherine M.; Wei, Yuling.

In: Hepatology, Vol. 24, No. 1, 01.01.1996, p. 89-96.

Research output: Contribution to journalArticle

Hoofnagle, JH, Lombardero, M, Zetterman, RK, Lake, J, Porayko, M, Everhart, J, Belle, SH, Detre, KM & Wei, Y 1996, 'Donor age and outcome of liver transplantation', Hepatology, vol. 24, no. 1, pp. 89-96. https://doi.org/10.1053/jhep.1996.v24.pm0008707288
Hoofnagle JH, Lombardero M, Zetterman RK, Lake J, Porayko M, Everhart J et al. Donor age and outcome of liver transplantation. Hepatology. 1996 Jan 1;24(1):89-96. https://doi.org/10.1053/jhep.1996.v24.pm0008707288
Hoofnagle, Jay H. ; Lombardero, Manuel ; Zetterman, Rowen K ; Lake, John ; Porayko, Michael ; Everhart, James ; Belle, Steven H. ; Detre, Katherine M. ; Wei, Yuling. / Donor age and outcome of liver transplantation. In: Hepatology. 1996 ; Vol. 24, No. 1. pp. 89-96.
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N2 - To evaluate the effect of donor age on graft and patient outcome after liver transplantation an analysis of a large-scale cohort study was performed at three tertiary referral liver transplant centers. Between April 1990 and June 1994, 772 adults underwent an initial single-organ liver transplantion. The age of the donors averaged 35 years; 193 (25%) were 50 or above, the age used to define 'older' donors. Groups were compared for demographic, clinical, and biochemical features. Outcome was measured using results of biochemical tests after transplantation and by graft and patient survival. Compared with younger donors, older donors were more commonly women (59% vs. 33%: P ≤ .001) and died of central nervous system causes (79% vs. 28%) as opposed to trauma (13% vs. 63%: P ≤ .001). The recipients of the two groups of donor livers did not differ in important respects. However, intraoperatively, livers from older donors were more likely to be assessed as either 'poor' or 'fair' as opposed to 'good' (17% vs. 4%: P ≤ .001) by the harvesting surgeon and to have initial 'poor' or 'fair' bile production (29% vs. 18%: P ≤ .001). During the first week postoperatively, the serum aminotransferase and bilirubin levels and prothrombin times were higher in recipients of older than those of younger donor livers. During followup, graft survival was less for recipients of older donor livers at 3 months (81% vs. 91%: P = .0001) and at 1 (76% vs. 85%: P = .007) and 2 years (71% vs. 80%: P = .005); patient survival showed similar though less marked differences. This association of donor age and poorer graft survival persisted after adjusting for many variables using bivariate and multivariate analyses. Importantly, however, the association with poor graft survival was largely among recipients of older donor livers, the quality of which was assessed as fair or poor by the harvesting surgeon; recipients of older donor livers assessed as good had a retransplant-free survival similar to that of younger donor livers (87% vs. 91% at 3 months). Thus, use of older donor livers, the quality of which are judged to be good by the harvesting surgeon, is not associated with a decrease in patient or graft survival after liver transplantation.

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