Liver grafts from selected older donors do not have significantly more ischaemia reperfusion injury

Abstract

Background: There is a general concern that aged organs are more susceptible to ischaemia. In the light of recent proposals to change the liver allocation system by expanding regional sharing, it is feared that increased cold ischaemia time of grafts from older donors may reduce graft survival. The aim of this study was to correlate donor age and the patterns of ischaemia reperfusion injury and synthetic function early after liver transplantation.

Methods: We performed a retrospective study of first transplants using a single-centre electronic database. Patterns of liver injury (based on transaminases and post-reperfusion biopsy), synthetic function (international normalized ratio [INR]), and graft and patient survival in recipients receiving liver grafts from donors aged ≥ 65 years (group 1, n= 50) were compared with equivalent patterns in a matched cohort of recipients transplanted with grafts from donors aged <65 years (group 2, n= 50).

Results: There was no significant difference in transaminase levels from day 0 to day 6 after transplantation. When groups 1 and 2 were subdivided into two subgroups based on the duration of graft cold ischaemia time (<8 h and ≥ 8 h), there was no statistical difference in transaminase levels during the first 7 days. There were two cases (4%) of primary non-function in group 1 and one (2%) in group 2. Initial poor function did not differ significantly between the groups (26% vs. 24%; P= 0.81). In addition, there was no difference in histological changes in post-reperfusion biopsies (21% vs. 34%; P= 0.078) and rate of acute rejection episodes in the first year (30% vs. 32%; P= 0.99). There was no significant difference between groups 1 and 2 in 1-year patient and graft survivals (78% vs. 90% [P= 0.17]; 88% vs. 94% [P= 0.48], respectively).

Conclusions: Judiciously selected livers from aged donors are not associated with major increased susceptibility to ischaemia reperfusion injury.

Figure 1

Seven-day curves showing (A) AST (aspartate aminotransferase), (B) ALT (alanine aminotransferase), (C) total bilirubin and (D) INR (international normalized ratio) in recipients of grafts aged ≥65 years vs. recipients of grafts aged <65 years (n= 50 per group). AST and bilirubin levels in recipients of grafts from older donors were significantly elevated only at days 6 and 7 (P= 0.01, P= 0.01 and P= 0.002, P= 0.004, respectively). ALT and INR levels did not differ significantly between the two groups in the first 7 days. Error bars represent the standard error of the mean

Figure 2

Seven-day curves showing (A) AST (aspartate aminotransferase), (B) ALT (alanine aminotransferase), (C) total bilirubin and (D) INR (international normalized ratio) in four groups of recipients of grafts aged ≥65 years or <65 years with cold ischaemia time of <8 h or ≥8 h. There was no statistical difference in any of these parameters among these groups. CIT, cold ischaemia time

Figure 3

One-year patient survival curves after transplantation. Although 1-year survival was lower in recipients of livers from donors aged ≥65 years (78% vs. 90%), this difference did not reach statistical significance (n= 50 per group; P= 0.13). The most common cause of death in both groups was sepsis

Figure 4

Rejection-free survival within 1 year after transplantation (time until first episode of biopsy-proven acute cellular rejection in the first year). There was no difference between the two groups in the timing and number of rejection episodes (n= 50 per group; P= 0.24)