• Antivirales de acción directa
• Direct-acting antivirals
• HCV recipients
• Octogenarian
• Octogenario
• Receptores VHC positivos

• Humans
• Liver Transplantation
• Antiviral Agents/therapeutic use
• Male
• Female
• Tissue Donors
• Middle Aged
• Aged, 80 and over
• Retrospective Studies
• Treatment Outcome
• Hepatitis C/drug therapy
• Hepatitis C/complications
• Aged
• Hepatitis C, Chronic/drug therapy
• Hepatitis C, Chronic/complications
• Age Factors
• Graft Survival

• Age limit
• ageism
• organ transplantation
• policy change
• qualitative

• Humans
• Israel
• Qualitative Research
• Organ Transplantation
• Male
• Female
• Interviews as Topic
• Waiting Lists
• Transplant Recipients/psychology
• Middle Aged
• Medical Staff/psychology
• Adult
• Attitude of Health Personnel
• Age Factors
• Health Policy
• Tissue and Organ Procurement

• Humans
• Liver Transplantation/standards
• Germany
• Gastroenterology/standards
• Practice Guidelines as Topic
• Societies, Medical

• donor age
• elderly donors
• liver transplantation
• outcomes
• propensity score matching

• Cox proportional hazard models
• Elderly donors
• Liver transplantation
• Postoperative complications
• Survival analysis

• deceased donor liver transplantation
• donor evaluation
• donor selection
• liver transplantation
• living donor liver transplantation

• Biliary complications
• Biliary strictures
• Liver transplant
• Octogenarian donors
• Older liver
• Septuagenarian donors

• Humans
• Young Adult
• Aged
• Infant, Newborn
• Infant
• Child, Preschool
• Child
• Middle Aged
• Liver Transplantation/adverse effects
• Living Donors
• Time Factors
• Tissue Donors
• Kidney Transplantation
• Survival Analysis
• Graft Survival
• Age Factors
• Retrospective Studies

Based on the renaissance of dynamic preservation techniques, extended criteria donor (ECD) livers reclaimed a valuable eligibility in the transplantable organ pool. Being more vulnerable to ischemia, ECD livers carry an increased risk of early allograft dysfunction, primary non-function and biliary complications and, hence, unveiled the limitations of static cold storage (SCS). There is growing evidence that dynamic preservation techniques—dissimilar to SCS—mitigate reperfusion injury by reconditioning organs prior transplantation and therefore represent a useful platform to assess viability. Yet, a debate is ongoing about the advantages and disadvantages of different perfusion strategies and their best possible applications for specific categories of marginal livers, including organs from donors after circulatory death (DCD) and brain death (DBD) with extended criteria, split livers and steatotic grafts. This review critically discusses the current clinical spectrum of livers from ECD donors together with the various challenges and posttransplant outcomes in the context of standard cold storage preservation. Based on this, the potential role of machine perfusion techniques is highlighted next. Finally, future perspectives focusing on how to achieve higher utilization rates of the available donor pool are highlighted.

• donation after circulatory death
• extended criteria donors
• machine perfusion
• mitochondria

Liver transplantation (LTx) is the only treatment option for patients with end-stage liver disease. Novel organ preservation techniques such as hypothermic machine perfusion (HMP) or normothermic machine perfusion (NMP) are under investigation in order to improve organ quality from extended criteria donors and donors after circulatory death. The aim of this study was to systematically review the literature reporting LTx outcomes using NMP or HMP compared to static cold storage (SCS).

The following data were retrieved: graft primary nonfunction rate, early allograft dysfunction (EAD) rate, biliary complication rate, and 12-month graft and patient survival. A total of 15 studies were included (6 NMP and 9 HMP studies), and meta-analysis was performed only for HMP studies because NMP had considerable differences.

The systematic review showed the potential of NMP to reduce graft injury and lower the liver graft discard rate. The performed quantitative analyses showed that the use of HMP reduces the rate of EAD (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.34–0.76; p = 0.001; I² = 0%) and non-anastomotic biliary strictures (OR 0.34; 95% CI 0.17–0.67; p = 0.002; I² = 0%) compared to SCS.

Our systematic review and meta-analysis revealed that the use of HMP reduces the rate of EAD and non-anastomotic biliary strictures compared to SCS.

• Direct-acting antivirals
• Hepatitis C virus
• Liver transplantation
• Octogenarian donors
• Older liver donors
• Septuagenarian donors

Donor age is an important predictor for liver transplant recipients. Studies have not fully explored its impact on transplant outcomes in hepatocellular carcinoma (HCC) patients as well as its involvement in tumor recurrence.

HCC patients who received liver transplants during 2010–2017 from the Scientific Registry of Transplant Recipients database were included. The recipients were divided into four groups based on donor age: I (≤ 34 years), II (35–49 years), III (50–64 years), and IV (≥ 65 years). Transplant outcomes, including the overall survival (OS), tumor recurrence, and risks, were evaluated.

A total of 13,276 HCC recipients were included in this study. Statistical significant differences were observed in OS among the four groups. The best 5-year survival was 76.0% in group I, followed by 73.5% in group II, 72.8% in group III, and 69.2% in group IV (P < 0.001). However, the liver-specific survival did not differ among these groups (P = 0.260). Donor age was found to be the independent predictor of OS after adjusting for other variables (P < 0.001, ref. group I; 1.087 (0.979–1.208) for group II, P = 0.119; 1.124 (1.015–1.246) for group III, P = 0.025; 1.395 (1.215–1.602) for group IV, P < 0.001). In subgroup analysis, OS was significantly different in recipients with hepatitis C virus (HCV), but there was no significant difference for recipients with hepatitis B virus (HBV), alcoholic liver diseases and nonalcoholic steatohepatitis (NASH). The post-transplant cumulative tumor recurrence rates were similar among the four groups (P = 0.382).

Older donor age was associated with decreased OS but not liver-specific survival as well as post-transplant tumor recurrence in HCC recipients. Donor age also had different effects in patients with different underlying liver diseases.

The online version contains supplementary material available at 10.1186/s12876-021-01786-6.

• Donor age
• Hepatocellular carcinoma
• Liver transplantation
• Outcome
• SRTR

An increase in the average life expectancy, paralleled by a demographic shift in the population with end-stage liver disease lies behind the rising demand for liver transplantation (LT) among the elderly. Some of the most common indications for LT including hepatocellular carcinoma, alcohol-related liver disease, chronic hepatitis C and non-alcoholic fatty liver disease tend to affect older patients. Transplant professionals are faced with an increasing demand for LT among elderly patients in an age of organ shortage and it is important that risk and benefits are carefully weighed in order to achieve the optimum use of precious liver grafts.

• Liver transplantation
• Elderly
• Hepatocellular carcinoma
• Alcohol-related liver disease
• Non-alcoholic fatty liver disease
• Hepatitis C virus

• diuretics
• glomerular filtration rate
• graft survival
• liver transplantation
• living donors

• Adult
• Aged
• Diuretics/pharmacology
• End Stage Liver Disease/physiopathology
• End Stage Liver Disease/surgery
• Female
• Glomerular Filtration Rate/drug effects
• Glomerular Filtration Rate/physiology
• Graft Survival/drug effects
• Graft Survival/physiology
• Humans
• Kidney/physiopathology
• Liver Transplantation
• Living Donors
• Male
• Middle Aged
• Prognosis
• Retrospective Studies

• Aging
• Allocation
• Donor age
• Immunosenescence
• Ischemia reperfusion injury
• Liver transplantation
• Old

• Age Factors
• Aging
• Donor Selection
• Humans
• Immunosenescence
• Liver Transplantation
• Reperfusion Injury/epidemiology
• Resource Allocation
• Tissue Donors
• Treatment Outcome

Liver resection is a standard treatment for hepatocellular carcinoma (HCC). The purpose of this study was to investigate the clinicopathological characteristics and long-term outcomes of octogenarians with HCC treated with liver resection. Records of patients who underwent liver resection for HCC were reviewed, and patients older and younger than 80 years were compared. There were 77 patients 80 years of age or older and 3,309 younger than 80 years. Hepatitis C virus infection was the most common etiology among the octogenarians (43.1%), followed by non-viral causes (37.5%). The older group had more co-morbidity but less hepatitis B virus infection and cirrhosis. More than 70% of the non-viral older group had diabetes mellitus, as compared to only 21.6% in the viral older group. The older group had rates of perioperative morbidity, mortality, disease-free survival, and overall survival comparable to the younger group (all p>0.1). Multivariate analysis revealed that α-fetoprotein ≥400 ng/mL, tumor size ≥10 cm, and vascular invasion were independent prognostic factors for overall survival in the older patients. These findings demonstrate that liver resection is a justified treatment for HCC in octogenarians, and it can achieve surgical outcomes comparable to those in younger populations.

• elderly
• hepatic resection
• hepatocellular carcinoma
• octogenarian

• Dyslipidemic donor
• Early allograft dysfunction
• Histopathology
• Portal fibrosis

• Biliary complications
• Graft survival
• Liver transplantation
• Octogenarian donors
• Systematic review

• Age
• Deceased donor transplantation
• Donation after circulatory death
• Liver transplantation
• Living donor liver transplantation
• Waiting list mortality

• extended criteria donors
• machine perfusion
• marginal graft
• orthotopic liver transplantation

Liver transplantation has become an important treatment modality for patients with end-stage liver disease/cirrhosis, acute liver failure, and hepatocellular carcinoma. Although surgical techniques and immunosuppressive regimens for liver transplantation have improved significantly over the past 20 years, infectious complications continue to contribute to the morbidity and mortality in this patient population. The use of standardized screening protocols for both donors and recipients, coupled with targeted prophylaxis against specific pathogens, has helped to mitigate the risk of infection in liver transplant recipients. Patients with chronic liver disease and cirrhosis have immunological deficits that place them at increased risk for infection while awaiting liver transplantation. The patient undergoing liver transplantation is prone to develop healthcare-acquired infections due to multidrug-resistant organisms that could potentially affect patient outcomes after transplantation. The complex nature of liver transplant surgery that involves multiple vascular and hepatobiliary anastomoses further increases the risk of infection after liver transplantation. During the early post-transplantation period, healthcare-acquired bacterial and fungal infections are the most common types of infection encountered in liver transplant recipients. The period of maximal immunosuppression that occurs at 1–6 months after transplantation can be complicated by opportunistic infections due to both primary infection and reactivation of latent infection. Severe community-acquired infections can complicate the course of liver transplantation beyond 12 months after transplant surgery. This chapter provides an overview of liver transplantation including indications, donor-recipient selection criteria, surgical procedures, and immunosuppressive therapies. A focus on infections in patients with chronic liver disease/cirrhosis and an overview of the specific infectious complications in liver transplant recipients are presented.

To increase the number of available grafts.

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).

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).

A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.

• Liver transplantation
• Aged donors
• Old donors
• Marginal donors
• Donor age

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Case-Control Studies
• Donor Selection/statistics & numerical data
• End Stage Liver Disease/mortality
• End Stage Liver Disease/pathology
• End Stage Liver Disease/surgery
• End Stage Liver Disease/virology
• Female
• Graft Survival
• Hepacivirus/isolation & purification
• Humans
• Liver Transplantation/adverse effects
• Liver Transplantation/methods
• Male
• Middle Aged
• Prognosis
• Severity of Illness Index
• Tissue Donors/statistics & numerical data
• Young Adult

• Cold ischemia time
• Donor age
• Liver transplantation allocation algorithm based on maEDC
• Macrovesicular steatosis
• Major EDC

• Age
• Donor age
• Elderly
• Liver transplantation
• Outcome
• Success

• aged donors
• donors
• liver transplantation

• Liver transplantation (LT)
• hepatocellular carcinoma (HCC)
• hypothermic
• machine perfusion (MP)
• marginal grafts
• normothermic

When it comes to maximizing allograft function, the recipient is just as important as the liver graft itself. Whereas the “healthiest” of liver transplant candidates are likely to gain significant benefit from a liver graft of any quality, the sickest of candidates may still die despite transplantation with even an ideal liver. However, the very sick patients are precisely the ones who have the greatest need for liver transplantation—with any liver, regardless of quality—because they are most vulnerable to pretransplant death without one. How does one balance the urgent need for liver transplantation with optimization of the allograft’s function and utility for the very sick patient?

• Allografts/physiopathology
• Allografts/surgery
• Donor Selection/methods
• Donor Selection/standards
• End Stage Liver Disease/pathology
• End Stage Liver Disease/surgery
• Humans
• Liver/physiopathology
• Liver/surgery
• Liver Transplantation/adverse effects
• Liver Transplantation/methods
• Severity of Illness Index
• Time Factors
• Transplant Recipients
• Treatment Outcome

• K23 AG048337 NIA NIH HHS

Given the expected increase in the number of elderly recipients, details regarding how clinical factors influence the outcome in living donor liver transplantation (LDLT) for the elderly remain unclear. We examined the survival outcomes according to the results of donor age-based and graft volume–based analyses and assessed the impact of prognostic factors on the survival after LDLT for elderly recipients.

The 198 adult recipients were classified into 2 groups: an elderly group (n = 70, E group; ≥ 60 years of age) and a younger group (n = 128, Y group; <60 years of age). We analyzed the prognostic factors for the survival in the E group and the survival rate for both groups at several follow-up points and conducted subgroup analyses in the E group by combining the donor age (≥50 vs <50 years) and graft weight (GW)/standard liver volume (SLV) (≥40% vs <40%).

Donor age (hazard ratio [HR], 2.17; P = 0.062) and GW/SLV (HR, 1.80; P = 0.23) tended to have a high HR in the E group. The overall patient survival rates at 1, 3, and 5 years were 78.3%, 73.0%, and 61.0% in the E group, and 82.0%, 75.1%, and 69.2% in the Y group, respectively (P = 0.459). However, the outcomes tended to be worse in recipients of grafts from donors ≥50 years of age than in those with grafts from younger donors with GW/SLV < 40% (P = 0.048).

A worse outcome might be associated with aging of the donor, which leads to impairment of the graft function and liver regeneration. Both the graft volume and donor age should be considered when choosing grafts for LDLT in elderly patients.

• Organ donation
• Organ transplantation
• Perioperative care

• Adolescent
• Adult
• Age Factors
• Aged, 80 and over
• Blood Transfusion
• Databases, Factual
• Donor Selection/standards
• Female
• Graft Survival
• Humans
• Italy
• Liver Transplantation
• Logistic Models
• Male
• Multivariate Analysis
• Perioperative Care
• Postoperative Complications/epidemiology
• Retrospective Studies
• Risk Factors
• Young Adult

To analyse the impact of octogenarian donors in liver transplantation.

We present a retrospective single-center study, performed between November 1996 and March 2015, that comprises a sample of 153 liver transplants. Recipients were divided into two groups according to liver donor age: recipients of donors ≤ 65 years (group A; n = 102), and recipients of donors ≥ 80 years (group B; n = 51). A comparative analysis between the groups was performed. Quantitative variables were expressed as mean values and SD, and qualitative variables as percentages. Differences in properties between qualitative variables were assessed by χ² test. Comparison of quantitative variables was made by t-test. Graft and patient survivals were estimated using the Kaplan-Meier method.

One, 3 and 5-year overall patient survival was 87.3%, 84% and 75.2%, respectively, in recipients of younger grafts vs 88.2%, 84.1% and 66.4%, respectively, in recipients of octogenarian grafts (P = 0.748). One, 3 and 5-year overall graft survival was 84.3%, 83.1% and 74.2%, respectively, in recipients of younger grafts vs 84.3%, 79.4% and 64.2%, respectively, in recipients of octogenarian grafts (P = 0.524). After excluding the patients with hepatitis C virus cirrhosis (16 in group A and 10 in group B), the 1, 3 and 5-year patient (P = 0.657) and graft (P = 0.419) survivals were practically the same in both groups. Multivariate Cox regression analysis demonstrated that overall patient survival was adversely affected by cerebrovascular donor death, hepatocarcinoma, and recipient preoperative bilirubin, and overall graft survival was adversely influenced by cerebrovascular donor death, and recipient preoperative bilirubin.

The standard criteria for utilization of octogenarian liver grafts are: normal gross appearance and consistency, normal or almost normal liver tests, hemodynamic stability with use of < 10 μg/kg per minute of vasopressors before procurement, intensive care unit stay < 3 d, CIT < 9 h, absence of atherosclerosis in the hepatic and gastroduodenal arteries, and no relevant histological alterations in the pre-transplant biopsy, such as fibrosis, hepatitis, cholestasis or macrosteatosis > 30%.

• Older liver
• Donor age
• Marginal liver
• Liver transplant
• Aging liver

• Adult
• Age Factors
• Aged, 80 and over
• Allografts/pathology
• Bilirubin/blood
• Case-Control Studies
• End Stage Liver Disease/blood
• End Stage Liver Disease/mortality
• End Stage Liver Disease/surgery
• Female
• Follow-Up Studies
• Graft Survival
• Humans
• Kaplan-Meier Estimate
• Liver/pathology
• Liver Transplantation/adverse effects
• Liver Transplantation/methods
• Male
• Middle Aged
• Retrospective Studies
• Severity of Illness Index
• Tissue Donors/statistics & numerical data
• Tissue and Organ Harvesting/adverse effects
• Tissue and Organ Harvesting/methods
• Transplantation, Homologous/adverse effects
• Transplantation, Homologous/methods

• Centers for Disease Control and Prevention high-risk donors
• Disease transmission
• Donation after cardiac death
• Extended criteria donor
• Liver transplantation

• Elderly donors
• Extended criteria donors
• Liver transplantation
• Marginal donors

• Adolescent
• Adult
• Age Factors
• Aged
• Health Policy/legislation & jurisprudence
• Health Services Accessibility/ethics
• Health Services Accessibility/legislation & jurisprudence
• Humans
• Israel
• Middle Aged
• Organ Transplantation/adverse effects
• Organ Transplantation/ethics
• Organ Transplantation/legislation & jurisprudence
• Policy Making
• Risk Factors
• Tissue Donors/supply & distribution
• Tissue and Organ Procurement/ethics
• Tissue and Organ Procurement/legislation & jurisprudence
• Transplant Recipients/legislation & jurisprudence
• Young Adult