Liver transplants from older donors have worse outcomes in elderly recipients with renal dysfunction.
Schilke R, Safwan M, Nagai S, Abouljoud M, and Patel A. Liver transplants from older donors have worse outcomes in elderly recipients with renal dysfunction. Am J Transplant 2018; 18:958-959.
Am J Transplant
Background: Most end stage liver disease patients suffer from concomitant renal insufficiency. We aimed to study influence of donor age on outcomes in elderly liver transplant recipients with renal dysfunction. Methods: Retrospective data of elderly (≥60 years) liver recipients from national United Network for Organ Sharing registry (2002-2017) were analyzed. Recipients were grouped based on chronic kidney disease stages (1-5) by estimated glomerular filtration rate (eGFR) at transplant. Instantaneous graft loss, all-cause mortality and mortality due to graft failure was estimated for young donor (YD, <60) and old donor (OD, ≥60 years) recipients by hazard ratios. Hazard ratio interactions were estimated between stages to assess organ allocation priority. Results: Among 20372 recipients, 16503 (81.01%) received YD livers. Nearly half (50.31%) had eGFR <60 ml/min at time of transplant. In terms of graft loss, instantaneous 5-year risk for OD vs. YD recipients for stage 1, 2, 3, 4, and 5 was HR=1.27 P<0.001, 1.15 P=0.170, 1.09 P=0.126, 1.56 P<0.001, and 1.99 P<0.001, respectively. Hazard ratio differences studied among various stages, showed significant interactions only between stage 1 vs. 5 (P=0.020), 2 vs. 4 (P=0.049), 2 vs. 5 (P=0.012), 3 vs. 4 (P=0.004), and 3 vs. 5 (P=0.002). In terms of all-cause mortality, overall instantaneous risk for OD vs. YD recipients for stage 1, 2, 3, 4, and 5 was HR=1.24 P=0.004, 1.17 P=0.005, 1.07 P=0.17, 1.35 P=0.001, and 1.54 P<0.001, respectively. In terms of mortality due to graft failure, instantaneous 1-year risk for OD vs. YD recipients was non-significant for stage 1, 2, 3, 4, and 5 (HR=1.07 P=0.792, HR=0.97 P=0.900, HR=1.36 P=0.130, HR=1.90 P=0.061, and HR=3.03 P=0.093, respectively). No HR interactions were present in all-cause mortality and mortality due to graft failure among all stages. Conclusion: Elderly recipients with severe renal insufficiency (stage 4 & 5) compared to those with mild insufficiency (stages 2 & 3) who received livers from ODs had higher graft loss at any time period within 5 years. All-cause mortality showed a similar fi nding but mortality due to graft failure was not different. We believe allocation of YD livers to elderly recipients with severe renal dysfunction may be considered to improve overall graft outcomes. Further studies are required to obtain a better understanding of these results.