Evaluation of Early Graft Function from the Aged Brain-dead Donors

Jang, Eun Jung; Han, Young Seok; Choi, Dong Lak

Abstract

PURPOSE: The increasing number of recipients on the waiting list for orthotopic liver transplantation (OLT) and the scarcity of donors contribute to recipient's pre-transplantation mortality. So, the expansion of donor criteria has become necessary with the increasing number of liver transplantation candidates, as aged donors who have been considered to yield marginal organs.
METHODS
We retrospectively analyzed the 18 deceased donor liver transplantations which had been performed between November 2004 and December 2007. Nine patients received liver grafts from donors older than 50 years, the other 9 patients from donors younger than 40 years. Pre- transplantation characteristics of donors and the early graft outcomes of recipients were evaluated.
RESULTS
The pre- transplantation status of the patients who received the older and younger grafts was similar, except donor age. Graft function - as determined by peak aminotransferase levels, prothrombin time (INR) and total bilirubin level after transplantation - was not significantly different in older versus younger grafts. Length of ICU stay and hospital stay of recipients were not influenced from donor's pre-transplant status and cold ischemic time. Fatty changes on frozen section biopsy was related with length of recipient's ICU stay (P=0.049), but all enrolled donors had mild macrovesicular fatty changes (<30%) and fatty changes had no relationship with early graft function and total length of recipient's hospital stay.
CONCLUSION
Fifty to sixty-five years brain-dead donors could be transplanted with the same initial success as younger livers provided that other generally accepted donor criteria are satisfactory and the cold ischemic time is short. Further studies should be performed for long-term results and we must make effort to find donors older than 65 years.