Dataset Information

Quantifying the Effect of Transplanting Older Donor Livers Into Younger Recipients: The Need for Donor-recipient Age Matching.

ABSTRACT: BACKGROUND:Increasing recipient and donor age are independently associated with survival after liver transplantation (LT). Whether donor age differentially impacts post-LT outcomes based on recipient age is unknown. METHODS:This was a retrospective cohort study using Organ Procurement and Transplantation Network data. All adult deceased-donor, single organ, primary LTs from 2002 to 2015 were included. Donor and recipient age were categorized as younger than 40 years, 40 to 59 years, and 60 years or older. Mixed-effects survival analysis evaluated the risk of graft failure and death according to the interaction of donor and recipient age categories. RESULTS:Of 63 628 LTs, 6.6% were in recipients younger than 40 years, of which 51.4% used an age-matched donor younger than 40 years. There was a significant among-center variability unrelated to United Network for Organ Sharing region in the use of older organs in young recipients, ranging from 0% to 25% or greater (overall center median, 9.7%; interquartile range, 5.4-16.5%). There was a significant interaction between donor and recipient age (P < 0.05) such that the impact of older donor age was more pronounced in younger recipients. Transplanting livers from donors aged 40 to 59 years and 60 years or older was associated with worse graft survival in recipients younger than 40 years, but there was no difference based on donor age in recipients 60 years or older. CONCLUSIONS:There is a differential impact of using older donors in younger recipients than that in older recipients. Given their longer expected post-LT survival and the ethical imperative to maximize utilization of the scarce resource of transplantable livers, efforts should be made to allocate the highest-quality organs to those most likely to derive lasting benefit.

SUBMITTER: Bittermann T

PROVIDER: S-EPMC6249077 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Quantifying the Effect of Transplanting Older Donor Livers Into Younger Recipients: The Need for Donor-recipient Age Matching.

Bittermann Therese T Goldberg David S DS

Transplantation 20181201 12

<h4>Background</h4>Increasing recipient and donor age are independently associated with survival after liver transplantation (LT). Whether donor age differentially impacts post-LT outcomes based on recipient age is unknown.<h4>Methods</h4>This was a retrospective cohort study using Organ Procurement and Transplantation Network data. All adult deceased-donor, single organ, primary LTs from 2002 to 2015 were included. Donor and recipient age were categorized as younger than 40 years, 40 to 59 year ...[more]

PMID: 29965955

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Project description:ObjectiveOne of the main problems of lung transplantation is the shortage of organs as well as reduced survival rates. In the absence of an international standardized model for lung donor-recipient allocation, we set out to develop such a model based on the characteristics of past experiences with lung donors and recipients with the aim of improving the outcomes of the entire transplantation process.MethodsThis was a retrospective analysis of 404 lung transplants carried out at the Reina Sofía University Hospital (Córdoba, Spain) over 23 years. We analyzed various clinical variables obtained via our experience of clinical practice in the donation and transplantation process. These were used to create various classification models, including classical statistical methods and also incorporating newer machine-learning approaches.ResultsThe proposed model represents a powerful tool for donor-recipient matching, which in this current work, exceeded the capacity of classical statistical methods. The variables that predicted an increase in the probability of survival were: higher pre-transplant and post-transplant functional vital capacity (FVC), lower pre-transplant carbon dioxide (PCO2) pressure, lower donor mechanical ventilation, and shorter ischemia time. The variables that negatively influenced transplant survival were low forced expiratory volume in the first second (FEV1) pre-transplant, lower arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio, bilobar transplant, elderly recipient and donor, donor-recipient graft disproportion requiring a surgical reduction (Tailor), type of combined transplant, need for cardiopulmonary bypass during the surgery, death of the donor due to head trauma, hospitalization status before surgery, and female and male recipient donor sex.ConclusionsThese results show the difficulty of the problem which required the introduction of other variables into the analysis. The combination of classical statistical methods and machine learning can support decision-making about the compatibility between donors and recipients. This helps to facilitate reliable prediction and to optimize the grafts for transplantation, thereby improving the transplanted patient survival rate.

Project description:Background:Nephron endowment in renal transplantation is infrequently considered, but may have important implications for post kidney transplantation outcomes. In this population-cohort study, we analyzed the deceased-donor kidney transplant outcomes stratified by donor-to-recipient size ratios. Methods:Data for all deceased-donor adult kidney transplantation recipients between 2003 and 2015 were extracted from the UK Transplant Registry. We used weight as a surrogate marker for kidney size and defined the following mismatch categories (donor weight/recipient weight × 100): less than 75% (small donor kidney), 75% to 125% (weight matched kidney), and greater than 125% (large donor kidney). Univariable and multivariable analyses were undertaken to assess the relationship between this marker and patient outcomes. Results:Outcomes for 11 720 transplants were analyzed with weight mismatch stratified as follows; small donor kidney (n = 1608, 13.7%), weight matched kidney (n = 7247, 61.8%) and large donor kidney (n = 2865, 24.4%). On multivariable analysis, no significant differences were detected in overall (P = 0.876) or death-censored (P = 0.173) graft survival, or in rates of delayed graft function (P = 0.396) between these 3 groups. However, 12-month creatinine levels were found to decline progressively across the groups (P < 0.001), with adjusted averages of 144.2 ?mol/L for recipients of small donor kidneys, 134.7 ?mol/L in weight matched kidneys, and 124.9 ?mol/L in recipients of large donor kidneys. In addition, patient survival was found to be significantly shorter in recipients of larger kidneys than those with weight matched kidneys (hazard ratio, 1.21; 95% confidence interval, 1.05-1.40; P = 0.009), which is inconsistent with the existing literature. Conclusions:Our data demonstrate that 12-month creatinine is influenced by donor-to-recipient difference in body weight, but that no such difference is observed for either delayed graft function or death-censored graft survival. However, we observed increased mortality in recipients receiving larger kidneys; an observation which conflicts with the existing literature and warrants further investigation.

Dataset Information

Quantifying the Effect of Transplanting Older Donor Livers Into Younger Recipients: The Need for Donor-recipient Age Matching.

Publications

Quantifying the Effect of Transplanting Older Donor Livers Into Younger Recipients: The Need for Donor-recipient Age Matching.

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