Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 21, Issue 6, Pages 2200-2210Publisher
WILEY
DOI: 10.1111/ajt.16409
Keywords
clinical research; practice; donors and donation; donation after circulatory death (DCD); donors and donation; extended criteria; liver transplantation; hepatology; organ acceptance; organ allocation; organ procurement; organ procurement and allocation
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The study findings suggest that using older grafts from donors aged 70 years and above can lead to acceptable outcomes in a highly selected cohort at experienced transplant centers. Advanced age should not be considered an absolute contraindication for utilizing DCD grafts from donors aged 70 years and older.
The aim of the study was to assess the UK donation after circulatory death (DCD) liver transplant experience from donors >= 70 years. Nationwide UK DCD retrospective analysis was conducted between 2001 and 2015 (n = 1163). Recipients were divided into group 1 vs. group 2 (donors 70 >= vs. <70 years, respectively). group 1 (n = 69, 5.9%) recipients were older (median 59 vs. 55 years, p = .001) and had longer waitlist time (128 vs. 84 days; p = .039). 94.2% of group 1 clustered in London and Birmingham, where the two busiest centers are located. group 1 allografts had higher UKDRI and UK DCD Risk Scores but similar WIT and CIT and were more likely to have been imported. Both groups had similar 1-, 3-, and 5-year graft survival (group 1, 90%, 81.4%, and 74% vs. group 2, 88.6%, 81.4%, and 78.6%, respectively; p = .54). Both groups had similar ICU stay length (p = .22), 3-month hepatic artery thrombosis rates (4.4% vs 4.0%; p = .9), and 12-month readmission rates for all biliary complications (20.3% vs 25.7%; p = .32). This study demonstrates that acceptable outcomes are achievable using older grafts in a highly selected cohort at experienced centers. Advanced age should not be an absolute contraindication to utilizing a DCD graft from donors aged >= 70 years.
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