TY - JOUR
T1 - Survival benefit of accepting livers from deceased donors over 70 years old
AU - Haugen, Christine E.
AU - Bowring, Mary G.
AU - Holscher, Courtenay M.
AU - Jackson, Kyle R.
AU - Garonzik-Wang, Jacqueline
AU - Cameron, Andrew M.
AU - Philosophe, Benjamin
AU - McAdams-DeMarco, Mara
AU - Segev, Dorry L.
N1 - Funding Information:
The data reported here have been supplied by the Hennnepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR, OPTN/UNOS, or the US Government. Funding for this study was provided by the National Institute of Diabetes and Digestive and Kidney Disease and the National Institute on Aging: grant numbers F32AG053025 (PI: Christine Haugen), F32DK109662 (PI: Courtenay Holscher), F32DK113719 (PI: Kyle Jackson), K01AG043501 (PI: McAdams-DeMarco), R01AG055781 (PI: Mara McAdams-DeMarco), and K24DK101828 (PI: Dorry Segev).
Funding Information:
tion by the SRTR, OPTN/UNOS, or the US Government. Funding for this study was provided by the National Institute of Diabetes and Digestive and Kidney Disease and the National Institute on Aging: grant numbers F32AG053025 (PI: Christine Haugen), F32DK109662 (PI: Courtenay Holscher), F32DK113719 (PI: Kyle Jackson), K01AG043501 (PI: McAdams‐DeMarco), R01AG055781 (PI: Mara McAdams‐DeMarco), and K24DK101828 (PI: Dorry Segev).
Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/7
Y1 - 2019/7
N2 - Livers from older donors (OLDs; age ≥70) are risky and often declined; however, it is likely that some candidates will benefit from OLDs versus waiting for younger ones. To characterize the survival benefit of accepting OLD grafts, we used 2009-2017 SRTR data to identify 24 431 adult liver transplant (LT) candidates who were offered OLD grafts eventually accepted by someone. Outcomes from the time-of-offer were compared between candidates who accepted an OLD graft and matched controls within MELD ± 2 who declined the same offer. Candidates who accepted OLD grafts (n = 1311) were older (60.5 vs. 57.8 years, P <.001), had a higher median MELD score (25 vs. 22, P <.001), and were less likely to have hepatitis C cirrhosis (14.9% vs. 31.2%, P <.001). Five-year cumulative mortality among those who accepted versus declined the same OLD offer was 23.4% versus 41.2% (P <.001). Candidates who accepted OLDs experienced an almost twofold reduction in mortality (aHR:0.450.520.59, P <.001) compared to those who declined the same offer, especially among the highest MELD (35-40) candidates (aHR:0.100.240.55, P =.001). Accepting an OLD offer provided substantial long-term survival benefit compared to waiting for a better organ offer, notably among candidates with MELD 35-40. Providers should consider these benefits as they evaluate OLD graft offers.
AB - Livers from older donors (OLDs; age ≥70) are risky and often declined; however, it is likely that some candidates will benefit from OLDs versus waiting for younger ones. To characterize the survival benefit of accepting OLD grafts, we used 2009-2017 SRTR data to identify 24 431 adult liver transplant (LT) candidates who were offered OLD grafts eventually accepted by someone. Outcomes from the time-of-offer were compared between candidates who accepted an OLD graft and matched controls within MELD ± 2 who declined the same offer. Candidates who accepted OLD grafts (n = 1311) were older (60.5 vs. 57.8 years, P <.001), had a higher median MELD score (25 vs. 22, P <.001), and were less likely to have hepatitis C cirrhosis (14.9% vs. 31.2%, P <.001). Five-year cumulative mortality among those who accepted versus declined the same OLD offer was 23.4% versus 41.2% (P <.001). Candidates who accepted OLDs experienced an almost twofold reduction in mortality (aHR:0.450.520.59, P <.001) compared to those who declined the same offer, especially among the highest MELD (35-40) candidates (aHR:0.100.240.55, P =.001). Accepting an OLD offer provided substantial long-term survival benefit compared to waiting for a better organ offer, notably among candidates with MELD 35-40. Providers should consider these benefits as they evaluate OLD graft offers.
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - clinical research/practice
KW - donors and donation: deceased
KW - donors and donation: extended criteria
KW - liver transplantation/hepatology
KW - organ acceptance
UR - http://www.scopus.com/inward/record.url?scp=85060576617&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060576617&partnerID=8YFLogxK
U2 - 10.1111/ajt.15250
DO - 10.1111/ajt.15250
M3 - Article
C2 - 30614634
AN - SCOPUS:85060576617
SN - 1600-6135
VL - 19
SP - 2020
EP - 2028
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -