Clinical

Donor age, recipient status predict liver transplant survival

Last Updated: 2005-03-23 15:11:33 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Three risk factors associated with liver transplantation -- a donor age older than 60 years, prolonged transplant cold storage time, and poor patient status prior to transplantation -- are associated with poor graft and patient survival, researchers at Vanderbilt University Medical Center report.

Because the supply of donor livers is inadequate to meet the demand, marginal donors are being used for liver transplantation, "and this has consequences," lead author Dr. Derek E. Moore and his associates in Nashville, Tennessee explain in their report, published in the March Archives of Surgery.

To assess the influence of various factors on liver transplant outcomes, Dr. Moore's group analyzed data from 483 adults who underwent primary orthotopic liver transplantation between 1991 and 2003.

Five-year graft survival was 72% when donors were younger than 60 years versus 35% when donors were older. The figure was 71% for grafts with less than 12 hours of cold ischemia time versus 58% for longer cold storage. For United Network for Organ Sharing (UNOS) urgency status 2B and 3, 5-year survival was 71% versus 60% for status 1 and 2A recipients.

The team's data suggest that when all three factors are optimal, odds of patient survival for 5 years would be 75%, compared with 20% if all three factors were suboptimal.

"Donor weight, warm ischemia time, sex mismatch, recipient age, creatinine level, total bilirubin level, and cause of liver disease did not significantly alter graft or patient survival," the researchers note.

Models based on pre-transplant characteristics "could be used to make recipient-specific organ allocation decisions at the time of graft procurement," they conclude.

Arch Surg 2005;140:273-277.