Octogenarian liver grafts: Is their use for transplant currently justified?

Table 1 Donor characteristics n (%)

Characteristics	Donors ≤ 65 yr	Donors ≥ 80 yr	P value
	Group A (n = 102)	Group B (n = 51)
Donor age (yr)	46.9 ± 15.0	83.5 ± 2.8	< 0.001
Sex (male/female)	62/40	13/38	< 0.001
Body mass index	26.9 ± 4.5	27.2 ± 5.4	0.670
> 30	26 (25.7)	15 (29.4)	0.800
Cause of donor death			0.006
Cerebrovascular	64 (62.7)	39 (76.5)
Head trauma	24 (23.5)	12 (23.5)
Anoxia	11 (10.8)	0
Other causes	3 (3.0)	0
ICU stay (h)	67.6 ± 79.6	49.9 ± 47.6	0.007
Vasopressor use	78 (76.5)	33 (64.7)	0.120
Cardiac arrest	26 (25.5)	1 (2.0)	< 0.001
Total bilirubin (mg/dL)	0.77 ± 0.74	1.05 ± 1.25	0.049
GOT (IU/L)	63 ± 76	30 ± 19	< 0.001
GPT (IU/L)	55 ± 69	22 ± 18	< 0.001
GGT (IU/L)	54 ± 61	38 ± 44	0.058
Prothrombin rate (%)	80 ± 20	77 ± 23	0.460
Sodium (meq/L)	147 ± 10	143 ± 5	0.001
Type of steatosis
Microsteatosis	26 (25.5)	11 (21.5)	0.590
Macrosteatosis	53 (52.0)	19 (37.3)	0.086
Grade of macrosteatosis
Mild (< 30%)	45 (44.1)	19 (37.3)	0.290
Moderate (30%-60%)	6 (5.9)	0 (0)	0.077
Severe (> 60%)	2 (2.0)	0 (0)
Preservation injury			0.140
Mild	39 (30.4)	14 (27.5)
Moderate	30 (26.5)	13 (25.5)
Severe	6 (5.9)	3 (5.8)
CIT (min)	406 ± 181	476 ± 132	0.091
WIT (min)	65 ± 15	59 ± 12	0.170

LT: Liver transplantation; ICU: Intensive care unit; GOT: Glutamic oxaloacetic transaminase; GPT: Glutamic pyruvic transaminase; GGT: γ-glutamyl transpeptidase.

Table 2 Recipient characteristics n (%)

Characteristics	Donors ≤ 65 years	Donors ≥ 80 years	P value
	Group A (n = 102)	Group B (n = 51)
Mean recipient age (yr)	52.6 ± 11.5	58.0 ± 8.7	0.044
Sex (male/female)	71/31	42/9	0.091
BMI	27.3 ± 4.0	27.3 ± 4.7	0.400
Etiology
Alcoholic cirrhosis	47 (46.1)	29 (56.9)	0.200
Viral C cirrhosis	16 (15.7)	10 (19.6)	0.540
Viral B cirrhosis	9 (8.8)	5 (9.8)	0.840
Hepatocarcinoma	24 (23.5)	18 (36.0)	0.100
Other	29 (28.4)	9 (17.6)	0.140
Child-Pugh distribution:			0.310
Grade A	19 (18.7)	13 (25.5)
Grade B	40 (39.2)	24 (47.0)
Grade C	43 (42.1)	14 (27.5)
MELD score	14.9 ± 5.5	14.5 ± 6.5	0.570
D-MELD score	706 ± 400	1205 ± 526	0.220
UNOS status:			0.160
Home	91 (89.2)	50 (98.1)
Hospital	9 (8.8)	1 (1.9)
ICU	2 (2.0)	0 (0)
Antecedents:
Diabetes	16 (15.7)	13 (25.5)	0.140
High blood pressure	19 (18.6)	13 (25.5)	0.320
Cardiopathy	20 (19.6)	12 (23.5)	0.570
Renal disease	8 (7.8)	3 (5.9)	0.650
Pre-LT laboratory values
Hemoglobin (g/100 mL)	11.5 ± 2.120	11.8 ± 2.3	0.300
Leukocytes/mm3	5264 ± 2060	5249 ± 2757	0.330
Platelets/mm3	97376 ± 55284	95568 ± 51651	0.910
Total bilirubin (mg/dL)	4.5 ± 7.5	2.7 ± 3.9	0.130
GOT (IU/L)	70 ± 59	74 ± 89	0.220
GPT (IU/L)	45 ± 36	51 ± 71	0.100
GGT (IU/L)	129 ± 159	100 ± 123	0.220
Alkaline phosphatase (IU/L)	233 ± 240	169 ± 129	0.067
Prothrombin rate (%)	63 ± 19	67 ± 21	0.650
Serum albumin (g/L)	3.36 ± 0.63	3.38 ± 0.64	0.570
Serum creatinine (mg/dL)	0.97 ± 0.42	1.07 ± 0.58	0.660
Serum glucose (mg/dL)	115 ± 47	143 ± 80	< 0.001

LT: Liver transplantation; ICU: Intensive care unit; GOT: Glutamic oxaloacetic transaminase; GPT: Glutamic pyruvic transaminase; GGT: γ-glutamyl transpeptidase.

Table 3 Intraoperative and post-liver transplantation characteristics n (%)

Characteristics	Donors ≤ 65 yr	Donors ≥ 80 yr	P value
	Group A (n = 102)	Group B (n = 51)
Biliary reconstruction:			0.090
Chol-Chol-without T-tube	86 (84.3)	49 (96.1)
Chol-Chol-with T-tube	12 (11.8)	2 (3.9)
Hepatico-jejunostomy	4 (3.9)	0
Transfusion
PRBC (mL)	3600 ± 4000	3320 ± 3748	0.390
Plasma (mL)	2520 ± 1842	2288 ± 1706	0.960
Platelets (units)	2.8 ± 3.1	2.2 ± 3.0	0.510
ICU stay (d)	5.1 ± 5.1	7.3 ± 8.5	0.015
Hospital stay (d)	21.9 ± 17.6	24.3 ± 17.6	0.520
Immunosuppression:			0.490
Cyclosporine	15 (14.7)	4 (7.8)
Tacrolimus	71 (69.6)	37 (72.6)
Tacrolimus + MMF	16 (15.7)	10 (19.6)

ICU: Intensive care unit; MMF: Mycophenolate mofetil.

Table 4 Comparison between the groups of liver function parameters

Parameters	Donors ≤ 65 yr	Donors ≥ 80 yr	P value
	Group A (n = 102)	Group B (n = 51)
GOT (IU/L)
1st d	763 ± 842	799 ± 1175	0.830
3rd d	183 ± 213	262 ± 254	0.076
7th d	67 ± 95	78 ± 74	0.470
30th d	31 ± 27	38 ± 43	0.260
GPT (IU/L)
1st d	697 ± 682	595 ± 525	0.370
3rd d	537 ± 650	484 ± 422	0.620
7th d	232 ± 198	217 ± 180	0.650
30th d	73 ± 104	51 ± 60	0.170
GGT (IU/L)
1st d	70 ± 71	61 ± 54	0.430
3rd d	167 ± 149	132 ± 102	0.100
7th d	272 ± 202	237 ± 157	0.310
30th d	226 ± 319	182 ± 205	0.390
A.Phosphatase (IU/L)
1st d	101 ± 82	120 ± 137	0.300
3rd d	148 ± 102	141 ± 101	0.690
7th d	172 ± 102	162 ± 155	0.640
30th d	262 ± 515	201 ± 236	0.440
Albumin (g/L)
1st d	2.9 ± 0.5	2.8 ± 0.7	0.280
3rd d	3.0 ± 0.5	2.7 ± 0.4	0.009
7th d	2.9 ± 0.4	2.5 ± 0.4	< 0.001
30th d	3.7 ± 0.8	3.5 ± 0.9	0.550
Prothrombin rate (%)
1st d	64 ± 18	56 ± 17	0.009
3rd d	86 ± 18	74 ± 17	< 0.001
7th d	91 ± 16	81 ± 18	0.001
30th d	90 ± 16	85 ± 18	0.990
Total bilirubin (mg/dL)
1st d	3.2 ± 3.3	4.0 ± 3.0	0.140
3rd d	2.4 ± 2.6	3.0 ± 2.9	0.260
7th d	2.7 ± 3.6	3.1 ± 38	0.450
30th d	1.7 ± 4.3	1.9 ± 4.4	0.780

Table 5 Post-liver transplantation complications, retransplant rate and mortality n (%)

Complications and mortality	Donors ≤ 65 yr	Donors ≥ 80 yr	P value
	Group A (n = 102)	Group B (n = 51)
Primary graft non-function	1 (0.98)	1 (1.96)	0.520
Acute rejection	33 (32.4)	10 (19.6)	0.110
Steroid-resistant rejection	6 (5.9)	1 (1.9)	0.200
Chronic rejection	2 (1.9)	1 (1.9)	0.980
Renal dysfunction	17 (16.7)	14 (27.5)	0.150
Renal filtration	1 (0.98)	4 (7.8)
Biliary	16 (15.7)	4 (7.8)	0.380
Vascular	4 (3.9)	0 (0)	0.350
Infections	24 (23.5)	12 (23.5)	0.940
Reoperations	8 (7.8)	4 (7.8)	0.970
HCV recurrence rate	64 (62.7)	34 (66.6)	0.530
Mean period (days from LT)	219 ± 119	251 ± 313	0.830
Retransplant cases	5 (4.9)	2 (3.9)	0.380
Primary non-function	1 (0.98)	1 (1.9)
Chronic rejection	1 (0.98)	0
Biliary complications	2 (1.96)	0
Hepatic artery thrombosis	1 (0.98)	0
HCV recurrence	0	1 (1.9)
Overall mortality	31 (30.4)	15 (29.4)	0.900
Causes of mortality
Cardiovascular	6 (5.9)	7 (13.7)
De novo tumors	8 (7.8)	1 (1.9)
Viral C recurrence	3 (2.9)	3 (5.9)
Infection	3 (2.9)	1 (1.9)
HCC recurrence	3 (2.9)	1 (1.9)
Chronic rejection	3 (2.9)	0 (0)
Primary non-function	1 (0.98)	0 (0)
Other	4 (3.9)	2 (3.9)

HCV: Hepatitis C virus; LT: Liver transplantation;

Table 6 Multivariate Cox regression analysis of predictors of patient and graft survival

Predictors of patient survival	HR	95%CI	P value
Donors ≤ 65 yr vs donors ≥ 80 yr	0.95	0.50-1.79	0.872
Cerebrovascular donor death	2.32	1.16-4.65	0.017
Hepatocarcinoma	2.28	1.21-4.29	0.011
Recipient preoperative bilirubin	1.05	1.02-1.09	0.004
Predictors of graft survival
Donors ≤ 65 yr vs donors ≥ 80 yr	0.84	0.43-1.62	0.596
Cerebrovascular donor death	2.22	1.08-4.58	0.030
Recipient preoperative bilirubin	1.04	1.01-1.08	0.008