Systematic Assessment of Safety Threshold for Donor Age in Cadaveric Liver Transplantation

Frontiers in Medicine

article

Wenchao Wang¹  Zhengtao Liu¹  Junjie Qian¹  Jun Xu¹  Shuping Que⁴  Li Zhuang⁶  Lei Geng¹  Lin Zhou¹  Shusen Zheng¹ 

[1] Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University;National Health Commission Key Laboratory of Combined Multi-organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences, First Affiliated Hospital, School of Medicine, Zhejiang University;Key Laboratory of Organ Transplantation, First Affiliated Hospital, School of Medicine, Zhejiang University;Science for Life Laboratory, Kungliga Tekniska Högskolan - Royal Institute of Technology;DingXiang Clinics;Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College

关键词: liver transplantation;    donor age;    mortality;    outcomes;    dose-response analysis;   

DOI  :  10.3389/fmed.2021.596552

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Donor age affects allograft quality and the prognosis of recipients after liver transplantation (LT). Clinicians have assessed the quality of grafts from older donors based on their appearance and texture, with no reliable quantitative evidence. Our study aimed to assess the quantitative impact of donor age on post-transplant outcomes and its safety threshold for LT, based on the published literature. Methods: Relevant studies were retrieved from the Embase, PubMed, and ISI Web of Science databases. Pooled dichotomous relative risks (RRs) were calculated using metan. Continuous RRs were calculated using a two-stage random-effects model. Results: Eleven studies including 30,691 LT cases were included for further analysis. For categorical comparison, the RR of death within the first post-transplant year was significantly higher among patients who received grafts from older donors. Similarly, the RR of graft failure (GF) was increased within the 3 years after transplantation. For continuous comparison, advanced donor age affected transplant outcomes in a linear manner ( P > 0.05). A 10-year increment in donor age was associated with RRs 1.10, 1.12, 1.15, 1.10, and 1.08 for 90-day, 180-day, 1-year, 3-year, and 5-year patient mortality and 1.08, 1.06, 1.10, 1.11, and 1.12, for 90-day, 180-day, 1-year, 2-year, and 3-year GF, respectively (all P 0.05). The risk of GF was increased in subgroups with fewer LT cases, longer cold ischemic time, fewer male donors, and recipients with viral hepatitis ( P < 0.05). Conclusion: Donor age might affect post-LT outcomes in a dose-dependent manner. The safety threshold for donor age in terms of GF should be lowered to 43 years as an early warning for the guarantee of satisfactory outcomes. Clinicians should weigh the benefits against the risks carefully for patients receiving grafts from older donors. Further studies are warranted to investigate the mechanisms responsible for the relationship between donor age and graft quality.

【 授权许可】

CC BY