Reappraisal of Donor Age in Liver Transplantation: NASH as a Potential Target to Safely Utilize Old Liver Grafts

Author:

Kusakabe Jiro12,Kozato Akio3,Tajima Tetsuya4,Bekki Yuki5,Fujiki Masato1,Tomiyama Koji6,Nakamura Tsukasa7,Matsushima Hajime1,Hashimoto Koji1,Sasaki Kazunari4

Affiliation:

1. Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.

2. Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

3. Department of Surgery, Columbia University Irving Medical Center, New York, NY.

4. Division of Abdominal Transplant, Department of General Surgery, Stanford University Medical Center, Stanford, CA.

5. Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, NY.

6. Department of Solid Organ Transplant Surgery, University of Rochester Medical Center, Rochester, NY.

7. Transplantation Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Abstract

Background. With the chronic shortage of donated organs, expanding the indications for liver transplantation (LT) from older donors is critical. Nonalcoholic steatohepatitis (NASH) stands out because of its unique systemic pathogenesis and high recurrence rate, both of which might make donor selection less decisive. The present study aims to investigate the usefulness of old donors in LT for NASH patients. Methods. The retrospective cohort study was conducted using the Scientific Registry Transplant Recipient database. The cohort was divided into 3 categories according to donor age: young (aged 16–35), middle-aged (36–59), and old donors (60–). Multivariable and Kaplan-Meier analyses were performed to compare the risk of donor age on graft survival (GS). Results. A total of 67 973 primary adult donation-after-brain-death LTs (2002–2016) were eligible for analysis. The multivariable analysis showed a reduced impact of donor age on GS for the NASH cohort (adjusted hazard ratio = 1.13, 95% confidence interval, 1.00-1.27), comparing old to middle-aged donors. If the cohort was limited to NASH recipients plus 1 of the following, recipient age ≥60, body mass index <30, or Model of End Stage Liver Disease score <30, adjusted hazard ratios were even smaller (0.99 [0.84–1.15], 0.92 [0.75–1.13], or 1.04 [0.91–1.19], respectively). Kaplan-Meier analysis revealed no significant differences in overall GS between old- and middle-aged donors in these subgroups (P = 0.86, 0.28, and 0.11, respectively). Conclusions. Donor age was less influential for overall GS in NASH cohort. Remarkably, old donors were equivalent to middle-aged donors in subgroups of recipient age ≥60, recipient body mass index <30, or Model of End Stage Liver Disease score <30.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Transplantation

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