Older Donor Age is Associated with Worse Living Donor Liver Transplantation Outcomes in a National US Cohort
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 2Department of Surgery, University of Pennsylvania, Philadelphia, PA, 3Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
Meeting: 2022 American Transplant Congress
Abstract number: 1762
Keywords: Graft failure, Liver transplantation, Living donor, Post-operative complications
Topic: Clinical Science » Liver » 58 - Liver: Living Donor Liver Transplant and Partial Grafts
Session Information
Session Name: Liver: Living Donor Liver Transplant and Partial Grafts
Session Type: Poster Abstract
Date: Tuesday, June 7, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: To evaluate the impact of increasing living donor (LD) age on living donor liver transplantation (LDLT) outcomes in the U.S.
*Methods: A retrospective cohort of 3,539 LDLT recipients and their donors between 01/01/2005 and 12/31/2019 was identified using the United Network for Organ Sharing database. Multivariable Cox proportional hazards models evaluated LD age as a predictor of LDLT recipient and graft survival. The impact of increasing donor age on recipient outcomes was compared between LD and deceased donor (DD) recipients. Differences in donor post-operative outcomes were described.
*Results: Despite the recent expansion of LDLT, the rate of LDs aged ≥50 years has remained relatively constant, accounting for 13.94% in 2005 and 15.63% in 2019 (p=0.310). Recipient age and severity of illness were not different between donors aged <50, 50-55 and >55 (all p>0.1). Donors >55 were more often non-biologically related (62.24% vs 37.76% biological; p=0.000). Donor age did not influence liver lobe selection (p=0.072) or pre-donation liver biopsy (p=0.105). Accounting for recipient factors, LD age ≥50 years was independently associated with an adjusted hazard ratio (HR) of 1.48 (vs LD age 18-29 years; p=0.011) for recipient survival and 1.62 (p=0.001) for graft survival (Table). There was no interaction between LD age and recipient age (p=0.386 for recipient survival, p=0.987 for graft survival). There was a trend towards worse recipient outcomes with increasing LD versus DD age. For example, for patient survival: LD age ≥50 years led to an adjusted HR 1.47 (vs 18-29 years; p=0.013) versus 1.32 (vs 18-29 years; p<0.001) for DD age ≥50 years. There was a possible increased rate of early donor biliary complications for donors >55 years (7.1% vs 3.1% for age <50 years; p=0.075). Early (<6 weeks) LD vascular complications, reoperation and readmission were not different by age (all p>0.05).
*Conclusions: Older LDs remain infrequently used in the U.S. Increasing LD age is associated with inferior recipient outcomes. Donor outcomes were not definitively impacted by increasing age.
| Patient Survival | Graft Survival | |||
| Adjusted HR (95% CI) | p-value | Adjusted HR (95% CI) | p-value | |
| Living Donor Age, per 5-year increase | 1.07 (1.03-1.12) | <0.001 | 1.09 (1.05-1.12) | <0.001 |
| Living Donor Age 18-29 | Reference | 0.011 | Reference | 0.001 |
| Age 30-39 | 1.18 (0.95-1.46) | 1.29 (1.08-1.55) | ||
| Age 40-49 | 1.33 (1.06-1.65) | 1.40 (1.16-1.69) | ||
| Age 50+ | 1.48 (1.15-1.90) | 1.62 (1.31-2.00) |
To cite this abstract in AMA style:
Kanneganti M, Olthoff KM, Bittermann T. Older Donor Age is Associated with Worse Living Donor Liver Transplantation Outcomes in a National US Cohort [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/older-donor-age-is-associated-with-worse-living-donor-liver-transplantation-outcomes-in-a-national-us-cohort/. Accessed November 23, 2024.« Back to 2022 American Transplant Congress