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Using old liver grafts for liver transplantation: Where are the limits?

World Journal of Gastroenterology 2014年第31期20卷 10691-10702页

作者： Carlos Jiménez-Romero Oscar Caso Maestro félix cambra molero Iago Justo Alonso Cristina Alegre Torrado Alejandro Manrique Municio Jorge Calvo Pulido Carmelo Loinaz Segurola Enrique Moreno González Service of General and Digestive Surgery and Abdominal Organ Transplantation "Doce de Octubre" University Hospital

The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.

关键词： Old liver donors Liver transplantation Aging liver Liver graft Liver disease Aging Donor management Septuagenarian donors Octogenarian donors

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Incidence, risk factors and outcome of de novo tumors in liver transplant recipients focusing on alcoholic cirrhosis

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World Journal of Hepatology 2015年第7期7卷 942-953页

作者： Carlos Jiménez-Romero Iago Justo-Alonso félix cambra-molero Jorge Calvo-Pulido álvaro García-Sesma Manuel Abradelo-Usera Oscar Caso-Maestro Alejandro Manrique-Municio Service of General and Digestive Surgery Abdominal Organ Transplantation "Doce de Octubre" University Hospital Universidad Complutense de Madrid

Orthotopic liver transplantation(OLT) is an established life-saving procedure for alcoholic cirrhotic(AC) patients, but the incidence of de novo tumors ranges between 2.6% and 15.7% and is significantly increased in comparison with patients who undergo OLT for other etiologies. Tobacco, a known carcinogen, has been reported to be between 52% and 83.3% in AC patients before OLT. Other risk factors that contribute to the development of malignancies are dose-dependent immunosuppression, advanced age, viral infections, sun exposure, and premalignant lesions(inflammatory bowel disease, Barrett's esophagus). A significantly more frequent incidence of upper aerodigestive(UAD) tract, lung, skin, and kidney-bladder tumors has been found in OLT recipients for AC in comparison with other etiologies. Liver transplant recipients who develop de novo non-skin tumors have a decreased long-term survival rate compared with controls. This significantly lower survival rate is more evident in AC recipients who develop UAD tract or lung tumors after OLT mainly because the diagnosis is usually performed at an advanced stage. All transplant candidates, especially AC patients, should be encouraged to cease smoking and alcohol consumption in the pre- and postOLT periods, use skin protection, avoid sun exposure and over-immunosuppression, and have a yearly otopharyngolaryngeal exploration and chest computed tomography scan in order to prevent or reduce the incidence of de novo malignancies. Although still under investigation, substitution of calcineurin inhibitors for sirolimus or everolimus may reduce the incidence of de novo tumors after OLT.

关键词： De novo malignancies De novo tumorstobacco consumption Alcoholic cirrhosis De novocancer Liver transplant

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Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

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World Journal of Gastroenterology 2018年第47期24卷 5391-5402页

作者： Oscar Caso-Maestro Carlos Jiménez-Romero Iago Justo-Alonso Jorge Calvo-Pulido David Lora-Pablos Alberto Marcacuzco-Quinto félix cambra-molero Alvaro García-Sesma Marina Pérez-flecha Carlos Munoz- Arce Carmelo Loinaz-Segurola Alejandro Manrique-Municio Unit of HBP Surgery and Abdominal Organs Transplantation Department of General Surgery“12 de octubre” University HospitalMadrid 28041Spain Clinical Research Department Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)“12 de octubre” University HospitalMadrid 28041Spain

AIM To increase the number of available *** 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 fter the ones that were performed with donors ≥ 70 years old(control group).RESULTS 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). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.

关键词： Liver transplantation Aged donors Old donors Marginal donors Donor age

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