Age and liver transplantation

François Durand*, Josh Levitsky, François Cauchy, Hélène Gilgenkrantz, Olivier Soubrane, Claire Francoz

*Corresponding author for this work

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

The average age of liver transplant donors and recipients has increased over the years. Independent of the cause of liver disease, older candidates have more comorbidities, higher waitlist mortality and higher post-transplant mortality than younger patients. However, transplant benefit may be similar in older and younger recipients, provided older recipients are carefully selected. The cohort of elderly patients transplanted decades ago is also increasingly raising issues concerning long-term exposure to immunosuppression and aging of the transplanted liver. Excellent results can be achieved with elderly donors and there is virtually no upper age limit for donors after brain death liver transplantation. The issue is how to optimise selection, procurement and matching to ensure good results with elderly donors. The impact of old donor age is more pronounced in younger recipients and patients with a high model for end-stage liver disease score. Age matching between the donor and the recipient should be incorporated into allocation policies with a multistep approach. However, age matching may vary depending on the objectives of different allocation policies. In addition, age matching must be revisited in the era of direct-acting antivirals. More restrictive limits have been adopted in donation after circulatory death. Perfusion machines which are currently under investigation may help expand these limits. In living donor liver transplantation, donor age limit is essentially guided by morbidity related to procurement. In this review we summarise changing trends in recipient and donor age. We discuss the implications of older age donors and recipients. We also consider different options for age matching in liver transplantation that could improve outcomes.

Original languageEnglish (US)
Pages (from-to)745-758
Number of pages14
JournalJournal of Hepatology
Volume70
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Liver Transplantation
Tissue Donors
Transplants
End Stage Liver Disease
Brain Death
Mortality
Living Donors
Liver
Immunosuppression
Antiviral Agents
Comorbidity
Liver Diseases
Perfusion
Morbidity

Keywords

  • Age
  • Deceased donor transplantation
  • Donation after circulatory death
  • Liver transplantation
  • Living donor liver transplantation
  • Waiting list mortality

ASJC Scopus subject areas

  • Hepatology

Cite this

Durand, F., Levitsky, J., Cauchy, F., Gilgenkrantz, H., Soubrane, O., & Francoz, C. (2019). Age and liver transplantation. Journal of Hepatology, 70(4), 745-758. https://doi.org/10.1016/j.jhep.2018.12.009
Durand, François ; Levitsky, Josh ; Cauchy, François ; Gilgenkrantz, Hélène ; Soubrane, Olivier ; Francoz, Claire. / Age and liver transplantation. In: Journal of Hepatology. 2019 ; Vol. 70, No. 4. pp. 745-758.
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Durand, F, Levitsky, J, Cauchy, F, Gilgenkrantz, H, Soubrane, O & Francoz, C 2019, 'Age and liver transplantation', Journal of Hepatology, vol. 70, no. 4, pp. 745-758. https://doi.org/10.1016/j.jhep.2018.12.009

Age and liver transplantation. / Durand, François; Levitsky, Josh; Cauchy, François; Gilgenkrantz, Hélène; Soubrane, Olivier; Francoz, Claire.

In: Journal of Hepatology, Vol. 70, No. 4, 01.04.2019, p. 745-758.

Research output: Contribution to journalReview article

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AU - Durand, François

AU - Levitsky, Josh

AU - Cauchy, François

AU - Gilgenkrantz, Hélène

AU - Soubrane, Olivier

AU - Francoz, Claire

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N2 - The average age of liver transplant donors and recipients has increased over the years. Independent of the cause of liver disease, older candidates have more comorbidities, higher waitlist mortality and higher post-transplant mortality than younger patients. However, transplant benefit may be similar in older and younger recipients, provided older recipients are carefully selected. The cohort of elderly patients transplanted decades ago is also increasingly raising issues concerning long-term exposure to immunosuppression and aging of the transplanted liver. Excellent results can be achieved with elderly donors and there is virtually no upper age limit for donors after brain death liver transplantation. The issue is how to optimise selection, procurement and matching to ensure good results with elderly donors. The impact of old donor age is more pronounced in younger recipients and patients with a high model for end-stage liver disease score. Age matching between the donor and the recipient should be incorporated into allocation policies with a multistep approach. However, age matching may vary depending on the objectives of different allocation policies. In addition, age matching must be revisited in the era of direct-acting antivirals. More restrictive limits have been adopted in donation after circulatory death. Perfusion machines which are currently under investigation may help expand these limits. In living donor liver transplantation, donor age limit is essentially guided by morbidity related to procurement. In this review we summarise changing trends in recipient and donor age. We discuss the implications of older age donors and recipients. We also consider different options for age matching in liver transplantation that could improve outcomes.

AB - The average age of liver transplant donors and recipients has increased over the years. Independent of the cause of liver disease, older candidates have more comorbidities, higher waitlist mortality and higher post-transplant mortality than younger patients. However, transplant benefit may be similar in older and younger recipients, provided older recipients are carefully selected. The cohort of elderly patients transplanted decades ago is also increasingly raising issues concerning long-term exposure to immunosuppression and aging of the transplanted liver. Excellent results can be achieved with elderly donors and there is virtually no upper age limit for donors after brain death liver transplantation. The issue is how to optimise selection, procurement and matching to ensure good results with elderly donors. The impact of old donor age is more pronounced in younger recipients and patients with a high model for end-stage liver disease score. Age matching between the donor and the recipient should be incorporated into allocation policies with a multistep approach. However, age matching may vary depending on the objectives of different allocation policies. In addition, age matching must be revisited in the era of direct-acting antivirals. More restrictive limits have been adopted in donation after circulatory death. Perfusion machines which are currently under investigation may help expand these limits. In living donor liver transplantation, donor age limit is essentially guided by morbidity related to procurement. In this review we summarise changing trends in recipient and donor age. We discuss the implications of older age donors and recipients. We also consider different options for age matching in liver transplantation that could improve outcomes.

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KW - Liver transplantation

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KW - Waiting list mortality

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Durand F, Levitsky J, Cauchy F, Gilgenkrantz H, Soubrane O, Francoz C. Age and liver transplantation. Journal of Hepatology. 2019 Apr 1;70(4):745-758. https://doi.org/10.1016/j.jhep.2018.12.009