Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

Caso Maestro, Óscar; Jiménez Romero, Luis Carlos; Justo Alonso, Iago; Calvo Pulido, Jorge; Lora Pablos, David; Marcacuzco Quinto, Alberto Alejandro; Cambra Molero, Félix; García-Sesma Pérez-Fuentes, Álvaro; Pérez Flecha, Marina; Muñoz Arce, Carlos; Loinaz Segurola, Carmelo; Manrique Municio, Alejandro

Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

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https://www.wjgnet.com/1007-9327/full/v24/i47/5391.htm

Publication date

2018

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https://pubmed.ncbi.nlm.nih.gov/30598583/

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URI

https://hdl.handle.net/20.500.14352/99983

Citation

Caso-Maestro O, Jiménez-Romero C, Justo-Alonso I, Calvo-Pulido J, Lora-Pablos D, Marcacuzco-Quinto A, Cambra-Molero F, García-Sesma A, Pérez-Flecha M, Muñoz-Arce C, Loinaz-Segurola C, Manrique-Municio A. Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over. World J Gastroenterol. 2018 Dec 21;24(47):5391-5402. doi: 10.3748/wjg.v24.i47.5391

Abstract

AIM To increase the number of available grafts. METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation (LT) were performed with donors ≥ 70 years old (study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old (control group). RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus (HCV)-positivity [hazard ratio (HR) = 2.35; 95% confidence interval (CI): 1.55-3.56; P = 0.00]; recipient age (HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease (D-MELD) (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium (HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD (donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients (77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00).