In this study, our aim was to show the life expectancy according to donor age groups at 1, 3, 5, 10, 15, and 20 years after liver transplant in liver transplant recipients. In this retrospective study, we analyzed the survival rate of 236 patients who had liver transplant procedures between 1988 and 2021. The 5-year life expectancy of recipients with donors over age 50 years in the literature has been shown to vary between 50% and 80%. Little information could be found on life expectancy after 10, 15, and 20 years in other studies. In the studies from Haberal and colleagues, life expectancy at 10, 15, and 20 years was 49%, 42%, and 42%, respectively. This study presents an evidence-based example of the use of elderly donors to enlarge the donor pool.

Key words : Survival rate, Transplant outcomes

Introduction

The effects of donor age on liver transplant are well known. Advanced donor age is a risk factor for poor outcomes in liver transplant recipients. Measures to expand the donor pool are crucial to prevent mortality for patients on transplant wait lists. In this retrospective study, we analyzed survival rates in liver transplant recipients according to donor age groups.

Materials and Methods

In this retrospective cohort study, we investigated the survival rates of 236 patients who had liver transplants between 1988 and 2021. In the studies from Haberal and colleagues, liver transplant eliminated one of the key factors that would affect the patients’ life expectancy.^1-4 Dependent variables of the study were recipient’s life expectancy, and independent variables were donor type and age groups. We included donor age groups of 9 years and under, 10 to 19 years, 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, and 60 years and over. We uploaded data to SPSS software for statistical evaluation, for which we applied Kaplan-Meier analysis, Cox regression, t test, and chi-square test.

Results

The life expectancy (survival distribution) results of liver transplant recipients according to donor age groups at 1, 5, 10, 15, and 20 years after liver transplant in Turkey^1-4 and in the literature^5-11 are listed in Table 1. Life expectancy of donors over 50 years of age in the literature varies between 51% and 85% at 5 years. For donors aged 40 and over, the 5-year life expectancy of recipients varies between 46% and 59%. Kim and colleagues reported a 5-year survival rate of 46% in recipients with donors over 40 years of age.⁵ Ghinolfi and colleagues reported a 5-year survival of 81% in recipients with donors between age 60 and 69 years, of 75% with donors between age 70 and 79 years, and of 77% with donors over age 80 years.⁷ Ravaioli and colleagues reported a 5-year survival rate of 76% in recipients with donors over age 60 years. Thorsen and colleagues reported a 5-year survival rate of 73% in recipients with donors between age 75 and 86 years.⁹ Cescon and colleagues reported a 5-year survival rate of 85% in recipients with donors between age 50 and 59 years, 52% with donors between age 60 and 69 years, 65% with donors between age 70 and 79 years, and 71% with donors over age 80 years.

No information could be found on life expectancy at 10, 15, and 20 years in the other studies. However, in the studies from Haberal and colleagues, life expectancy at 10, 15, and 20 years was 49%, 42%, and 42%, respectively. Recipient survival duration according to deceased and living donors and donor age group at 1, 5, 10, 15, and 20 years in liver transplant recipients in Turkey is shown in Table 2. Means and medians of survival time according to Kaplan-Meier analyses are listed in Table 3. Table 4 shows results of pairwise comparisons.

Conclusions

This work aimed to show the life expectancy of liver transplant recipients according to age of donors at 1, 3, 5, 10, 15, and 20 years posttransplant in Turkey and in the literature. In the literature, life expectancy of recipients who had donors over 50 years of age has been shown to vary between 50% and 80% at 5 years. Although we could not find information in the literature at posttransplant times above 5 years, the studies from Haberal and colleagues reported life expectancy at 10, 15, and 20 years of 49%, 42%, and 42%, respectively. This study presents an evidence-based example of the use of elderly donors to enlarge the donor pool.

References:

1. Haberal M, Buyukpamukcu N, Telatar H, et al. Segmental living liver transplantation in children and adults. Transplant Proc. 1992;24(6):2687-2689.
   CrossRef - PubMed
2. Haberal M, Moray G, Bilgin N, et al. A preliminary report on heterotopic segmental living-related and/or split-liver cadaveric transplantation. Transplant Proc. 1999;31(7):2899-2901. Doi:10.1016/s0041-1345(99)00767-8
   CrossRef - PubMed
3. Haberal M, Karakayali H, Emiroglu R, Boyacioglu S, Arslan G, Bilgin N. Heterotopic liver transplantation during adolescence. Transplant Proc. 2001;33(5):2832-2833. Doi:10.1016/s0041-1345(01)02209-6
   CrossRef - PubMed
4. Haberal M, Emiroglu R, Arslan G, Karakayali H, Moray G, Bilgin N. Long-term survival with heterotopic liver transplantation. Transplant Proc. 2002;34(6):2468-2471. Doi:10.1016/s0041-1345(02)03179-2
   CrossRef - PubMed
5. Kim DY, Choi MS, Lee JH, et al. Older donor allografts are associated with poor patient survival after living donor liver transplantation for hepatitis B virus-related liver diseases. Liver Int. 2007;27(2):260-267. Doi:10.1111/j.1478-3231.2006.01403.x
   CrossRef - PubMed
6. Imamura H, Hidaka M, Soyama A, et al. A donor age-based and graft volume-based analysis for living donor liver transplantation in elderly recipients. Transplant Direct. 2017;3(7):e168. Doi:10.1097/TXD.0000000000000688
   CrossRef - PubMed
7. Ghinolfi D, Marti J, De Simone P, et al. Use of octogenarian donors for liver transplantation: a survival analysis. Am J Transplant. 2014;14(9):2062-2071. Doi:10.1111/ajt.12843
   CrossRef - PubMed
8. Ravaioli M, Grazi GL, Cescon M, et al. Liver transplantations with donors aged 60 years and above: the low liver damage strategy. Transpl Int. 2009;22(4):423-433. Doi:10.1111/j.1432-2277.2008.00812.x
   CrossRef - PubMed
9. Thorsen T, Aandahl EM, Bennet W, et al. Transplantation with livers from deceased donors older than 75 years. Transplantation. 2015;99(12):2534-2542. Doi:10.1097/TP.0000000000000728
   CrossRef - PubMed
10. Cescon M, Grazi GL, Cucchetti A, et al. Improving the outcome of liver transplantation with very old donors with updated selection and management criteria. Liver Transpl. 2008;14(5):672-679. Doi:10.1002/lt.21433
    CrossRef - PubMed
11. Dar FS, Khan NY, Ali R, et al. Recipient outcomes with younger donors undergoing living donor liver transplantation. Cureus. 2019;11(3):e4174. Doi:10.7759/cureus.4174
    CrossRef - PubMed