Background: Due to organ shortage, the use of older donors is an acceptable option to decrease waiting list mortality. However, survival outcomes of liver transplantation (LT) with octogenarian grafts remain controversial. Methods: Data were retrieved from the prospectively maintained databases of two Italian liver transplant centers (Bergamo and Ancona), including first, adult, non-urgent, ABO-identical LTs from January 2004 to June 2017. LTx with HCV positive and partial liver grafts were also excluded. Among 732 recipients included, 78 (10.7%) received an octogenarian graft (Oct-Group) and 654 a standard graft (18-79 years:Std-Group). A propensity score approach with 1:2 match was applied to balance 12 possible risk factors for graft loss related to the recipient (LT-year, age, gender, liver disease etiology, presence of HCC, lab-MELD) and to the donor (gender, cause of death, Na peak, BMI, anti-HBc positivity, cold ischemia time). Results: Oct-Group recipients were successfully matched with 156 Std-Group patients in terms of donor, recipient and perioperative characteristics. After a median follow-up of 51 (IQR:20.3-93.4) months, 1- 3- and 5-year patient survival was 85.4%, 75.3% and 71.1% in the Oct-Group vs 85.7%, 78.6% and 75.1% in the Std-Group, respectively (log-rank p-value:0.283). Five-year graft survival was also similar (Oct-Group: 69.8% vs 72.9% Std-Group; p-value: 0.423). Early (within 30 days) re-LTx rate (1.3% vs 1.3%; p-value:0.538) and HCV-related deaths (1.3 vs 2.6%; p-value:0.874) were identical in the two groups. Subgroup analysis revealed similar 5-year survival outcomes when octogenarian grafts were allocated in HCV positive (54.2% vs 68.1%;p-value:0.224) or higher (≥25) MELD (67.9% vs 65.2%; p-value:0.831) recipients. After multivariate analysis, the only independent prognostic factor for graft loss was a pre-LT MELD-score ≥ 30 [Exp(b):1.92;p-value:0.035]. Conclusions: Use of octogenarian grafts, even when these are allocated to high-risk recipients, is not associated with a worse outcome.
Effectiveness and safety of octogenarian donors in liver transplantation: propensity score matched study from two Italian liver transplant centers / Nicolini, D; Conte, G; Montalti, R; Mocchegiani, F; Coletta, M; Benedetti Cacciaguerra, A; Dalla Bona, E; Vecchi, A; Iaculli, E; Colledan, M; Vivarelli, M. - (2018). (Intervento presentato al convegno The 2018 Joint International Congress of ILTS, ELITA & LICAGE tenutosi a Lisbon, Portugal nel May 23-26, 2018).
Effectiveness and safety of octogenarian donors in liver transplantation: propensity score matched study from two Italian liver transplant centers
Montalti R;
2018
Abstract
Background: Due to organ shortage, the use of older donors is an acceptable option to decrease waiting list mortality. However, survival outcomes of liver transplantation (LT) with octogenarian grafts remain controversial. Methods: Data were retrieved from the prospectively maintained databases of two Italian liver transplant centers (Bergamo and Ancona), including first, adult, non-urgent, ABO-identical LTs from January 2004 to June 2017. LTx with HCV positive and partial liver grafts were also excluded. Among 732 recipients included, 78 (10.7%) received an octogenarian graft (Oct-Group) and 654 a standard graft (18-79 years:Std-Group). A propensity score approach with 1:2 match was applied to balance 12 possible risk factors for graft loss related to the recipient (LT-year, age, gender, liver disease etiology, presence of HCC, lab-MELD) and to the donor (gender, cause of death, Na peak, BMI, anti-HBc positivity, cold ischemia time). Results: Oct-Group recipients were successfully matched with 156 Std-Group patients in terms of donor, recipient and perioperative characteristics. After a median follow-up of 51 (IQR:20.3-93.4) months, 1- 3- and 5-year patient survival was 85.4%, 75.3% and 71.1% in the Oct-Group vs 85.7%, 78.6% and 75.1% in the Std-Group, respectively (log-rank p-value:0.283). Five-year graft survival was also similar (Oct-Group: 69.8% vs 72.9% Std-Group; p-value: 0.423). Early (within 30 days) re-LTx rate (1.3% vs 1.3%; p-value:0.538) and HCV-related deaths (1.3 vs 2.6%; p-value:0.874) were identical in the two groups. Subgroup analysis revealed similar 5-year survival outcomes when octogenarian grafts were allocated in HCV positive (54.2% vs 68.1%;p-value:0.224) or higher (≥25) MELD (67.9% vs 65.2%; p-value:0.831) recipients. After multivariate analysis, the only independent prognostic factor for graft loss was a pre-LT MELD-score ≥ 30 [Exp(b):1.92;p-value:0.035]. Conclusions: Use of octogenarian grafts, even when these are allocated to high-risk recipients, is not associated with a worse outcome.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
