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Patient Age Held Critical in Liver Transplantation


 

PALM BEACH, FLA. — The success of adult-to-adult living donor liver transplants hinges on careful candidate selection with close attention being paid to patient age, Kim Olthoff, M.D., said at the annual meeting of the American Surgical Association.

“Older age and cold ischemic time were associated with adverse outcomes in patients undergoing adult-to-adult living donor transplant. However, graft size was not a factor. Choice of appropriate recipient is critical,” explained Dr. Olthoff, principal investigator and surgical director of the liver transplant program at Children's Hospital of Philadelphia.

Dr. Olthoff and her researchers examined data on 354 patients who received adult liver donor transplants at nine different centers. The report formed part of the Adult-to-Adult Living Donor Transplantation (ALDLT) consortium, which aims to evaluate the success of ALDLT.

They found that in the first 90 days after transplantation, 44 grafts failed (18 patients died and 26 required retransplantation). Grafts failed most commonly because of vascular thrombosis, primary nonfunction, recurrent hepatitis, or sepsis. Researchers followed patients for a median of 2.2 years and utilized Cox models to examine the relationship between 35 intraoperative and postoperative variables along with the risk of graft failure. During that time, 7.3% of patients had vascular complications and 21% required further surgery.

The most significant factor predicting higher risk of graft failure was the age of the recipient, with a risk ratio of 1.04 per year and a statistical significance of P less than 0.0001, researchers stated. In addition, they noted that at centers where more than 15 transplants had been performed, the risk of graft failure was reduced by 45%, compared with centers where fewer transplants had been done.

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