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

World Journal of Gastroenterology 2017年第17期23卷 3099-3110页

作者： Carlos Jiménez-Romero Felix Cambra oscar caso Alejandro Manrique Jorge Calvo Alejandro Marcacuzco Paula Rioja David Lora Iago Justo HPB Surgery and Abdominal Organ Transplantation Unit University Hospital“Doce de Octubre” Department of Surgery Facultad de Medicina

AIMTo analyse the impact of octogenarian donors in liver *** 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 ***, 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 *** 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 s

关键词： Older liver Donor age Marginal liver Liver transplant Aging liver

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

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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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Post-transplant biliary complications using liver grafts from deceased donors older than 70 years:Retrospective case-control study

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1615-1628页

作者： Carlos Jimenez-Romero Iago Justo-Alonso Pilar del Pozo-Elso Alberto Marcacuzco-Quinto Cristina Martín-Arriscado-Arroba Alejandro Manrique-Municio Jorge Calvo-Pulido Alvaro García-Sesma Ricardo San Román oscar caso-Maestro Unit of HPB Surgery and Abdominal Organs Transplantation `12 de Octubre´University HospitalMadrid 28041Spain Clinical Research Unit(I+12) `12 de Octubre´University HospitalMadrid 28041Spain Department of Radiology `12 de Octubre´University HospitalMadrid 28041Spain

BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older *** To determine the incidence,outcomes,and risk factors for biliary complications(BC)in liver transplantation(LT)using liver grafts from donors aged>70 *** Between January 1994 and December 31,2019,297 LTs were performed using donors older than 70 *** excluding 47 LT for several reasons,we divided 250 LTs into two groups,namely post-LT BC(n=21)and without BC(n=229).This retrospective case-control study compared both *** Choledocho-choledochostomy without T-tube was the most frequent technique(76.2%in the BC group vs 92.6%in the non-BC group).Twenty-one patients(8.4%)developed BC(13 anastomotic strictures,7 biliary leakages,and 1 nonanastomotic biliary stricture).Nine patients underwent percutaneous balloon dilation and nine required a Rouxen-Y hepaticojejunostomy because of dilation *** incidence of post-LT complications(graft dysfunction,rejection,renal failure,and non-BC reoperations)was similar in both *** were no significant differences in the patient and graft survival between the ***,only three deaths were attributed to *** female donors were protective factors for BC,donor cardiac arrest was a risk *** The incidence of BC was relatively low on using liver grafts>70 *** could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy,without significant differences in the patient or graft survival between the groups.

关键词： Older liver Liver transplant Biliary complications Biliary strictures Septuagenarian donors Octogenarian donors

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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 < 70 years old immediately after 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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