Older donor age negatively affects survival of living donor LT recipient

CHICAGO — Older donor age in living donor liver transplantation negatively affected survival at 1 year and increased the risk of complications, according to a presenter at Digestive Disease Week.

“There have been studies that looked at regenerative capacity, and it has been shown that the capacity of regeneration is less in the older donor,” Wuttiporn Manatsathit, MD, from the department of gastroenterology, University of Nebraska, said in a presentation. “Our theory is that the effect of older donor in living donor liver transplant could be more prominent.”

The researchers reviewed the UNOS database for living donor recipients beginning in 2003 to include MELD score in their analysis. The study comprised two cohorts: 2,395 LT patients who received from donors younger than 50 years and 390 LT patients who received from donors age 50 years or older.

Both groups of LT recipients had similar age, percentage of men and women, average BMI of approximately 26 kg/m² and most patients were white. Additionally, both groups had similar rates of hepatic encephalopathy, ascites, pulmonary complication, hepatocellular carcinoma and mean MELD scores of 15.

Significant differences between the younger donor group and the older donor group included mean age (34.1 vs. 53.1 years; P < .001), percentage of men (50.5% vs. 39.2; P < .001), white ethnicity (82.3% vs. 90.3%; P = .002) and height (171.8 cm vs. 169.6 cm; P < .001). However, Manatsathit noted that the difference in height may be related to aging.

Overall survival at 1 year was not affected by age up to 49 years, but age 50 years and older was found to affect 1 year survival (HR = 1.84; 95% CI, 1.19-2.85). In graft-specific 1-year survival outcomes, there was mild significance for donor age 39 to 49 years (HR = 1.41; 95% CI, 1.05-1.89), but was significant in donors 50 years or older (HR = 1.98; 95% CI, 1.44-2.72).

There was a higher rate of complications in the older donor group compared with the younger donor group, including higher rates of primary graft failure (6.2% vs. 3.3%; P = .009), biliary graft failure (4.1% vs. 1.5%; P = .002) and acute rejection (1.5% vs. 0.4%; P = .02).

“It seems that older donor age actually has a negative impact on overall survival and graft survival in recipient after living donor transplantation,” Manatsathit said. “This negative effect seems to be more prominent in the first year and seems to be less after 2 to 5 years, which makes sense that the quality of the graft is the most important in terms of graft function which most likely important at first year.” – by Talitha Bennett

References:

Manatsathit W, et al. Abstract 279. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.

Disclosure : Manatsathit reports no relevant financial disclosures.