SpringerLink
Log in

Impact of the elderly donor on an abdominal organ transplantation program

  • original article
  • Published:
European Surgery Aims and scope Submit manuscript

Summary

Background

Older donors have become widespread in recent years. Given that they have comorbidities, the treatment of theses donors is crucial. Our aim was to analyze the influence of the elderly donor (≥65 years) on the subsequent evolution of liver and kidney recipients.

Methods

Retrospective study including all liver and kidney transplants performed at the Marqués de Valdecilla University Hospital with grafts generated from local donors in brain death. Period: 2014–2017. Two groups were considered, depending on the age of the donor (≥ or <65 years).

Results

There were 37 older donors (from 100 donors in brain death). Fourteen liver transplants were performed with old grafts that were characterized by a lower Model for End-stage Liver Disease (MELD) score (13.5 [interquartile range (IQR): 10–14] vs. 19 [IQR: 16–22], p: 0.004). The values of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were higher over time in the older graft recipients. 18 renal transplants were performed with grafts from older donors. This group were older (62 vs. 57, p: 0.001) and had longer hospital stay (25 vs. 17 days; p: 0.023). There were no significant differences in the development of primary graft disfunction or graft loss. Liver transplant survival and kidney survival were similar in both groups.

Conclusion

The use of elderly donors has not influenced the clinical evolution of liver and kidney transplants in our series. Older donors should no longer be considered suboptimal, because they offer a possibility for certain patients on the waiting list.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Spanish National Transplant Organization (NTO) Liver Transplant. 2018. http://www.ont.es/infesp/Memorias/Memoria%20Hepática%202017.pdf. Accessed 14 Jan 2019

  2. Spanish National Transplant Organization (NTO). Press release 2019. http://www.ont.es/Documents/Datos2019.pdf. Accessed 16 Jan 2019

  3. Gordon Burroughs S, Busuttil RW. Optimal utilization of extended hepatic grafts. Surg Today. 2009;39:746–51.

    Article  Google Scholar 

  4. Lué A, Solanas E, Baptista P, et al. How important is donor age in liver transplantation? World J Gastroenterol. 2016;22:4966–76.

    Article  Google Scholar 

  5. Moreso F, Seron D, Gil-Vernet S, et al. Donor age and delayed graft function. J Am Soc Nephrol. 2002;13:1067–72.

    Google Scholar 

  6. Dayoub JC, Cortese F, Anžič A, et al. The effects of donor age on organ transplants: a review and implications for aging research. Exp Gerontol. 2018;110:230–40.

    Article  Google Scholar 

  7. Díaz Jaime F, Berenguer M. Pushing the donor limits: deceased donor liver transplantation using organs from octogenarian donors. Liver Transpl. 2017;23(S1):S22–S6.

    Article  Google Scholar 

  8. Miñambres E, Coll E, Duerto J, et al. Effect of an intensive lung donor-management protocol on lung transplantation outcomes. J Heart Lung Transplant. 2014;33:178–84.

    Article  Google Scholar 

  9. Ballesteros MA, Duerto Álvarez J, Martín-Penagos L, et al. Influence of specific thoracic donor therapy on kidney donation and long-term kidney graft survival. J Nephrol. 2017;30:869–75.

    Article  Google Scholar 

  10. Miñambres E, Suberviola B, Dominguez-Gil B, et al. Improving the outcomes of organs obtained from controlled donation after circulatory death donors using abdominal normothermic regional perfusion. Am J Transplant. 2017;17:2165–72.

    Article  Google Scholar 

  11. Miñambres E, Rubio JJ, Coll E, et al. Donation after circulatory death and its expansion in Spain. Curr Opin Organ Transplant. 2018;23(1):120–9.

    Article  Google Scholar 

  12. Suberviola B, Mons R, Ballesteros MA, et al. Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death. Am J Transplant. 2019;19(4):1195–201.

    Article  Google Scholar 

  13. Hamar M, Selzner M. Ex-vivo machine perfusion for kidney preservation. Curr Opin Organ Transplant. 2018;23:369–74.

    Article  Google Scholar 

  14. Nasralla D, Coussios CC, Mergental H, et al. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018;557(7703):50–6.

    Article  CAS  Google Scholar 

  15. Spanish National Transplant Organization (NTO). Kidney tranplant. 2018. http://www.ont.es/infesp/Memorias/Memoria%20Renal%202017_para%20colgar.pdf. Accessed 14 Jan 2019.

  16. Singhal A, Sezginsoy B, Ghuloom AE, et al. Orthotopic liver transplant using allografts from geriatric population in the United States: Is there any age limit? Exp Clin Transplant. 2010;8:196–201.

    PubMed  Google Scholar 

  17. Ghinolfi D, Marti J, De Simone P, et al. Use of octogenarian donors for liver transplantation: a survival analysis. Am J Transplant. 2014;14:2062–71.

    Article  CAS  Google Scholar 

  18. Rosengard BR, Feng S, Alfrey EJ, et al. Report of the Crystal City meeting to maximize the use of organs recovered from the cadaver donor. Am J Transplant. 2002;2:701–11.

    Article  Google Scholar 

  19. Meier-Kriesche HU, Cibrik DM, Ojo AO, et al. Interaction between donor and recipient age in determining the risk of chronic renal allograft failure. J Am Geriatr Soc. 2002;50:14–7.

    Article  Google Scholar 

  20. Stolyar AG, Budkar LN, Solodushkin SI, et al. Influence of factors associated with the deceased-donor on kidney transplant outcomes. Exp Clin Transplant. 2015;13(5):394–401.

    PubMed  Google Scholar 

  21. Tullius SG, Tran H, Guleria I, et al. The combination of donor and recipient age is critical in determining host immunoresponsiveness and renal transplant outcome. Ann Surg. 2010;252:662–74.

    PubMed  Google Scholar 

  22. Molnar MZ, Streja E, Kovesdy CP, et al. Age and the associations of living donor and expanded criteria donor kidneys with kidney transplant outcomes. Am J Kidney Dis. 2012;59:841–8.

    Article  Google Scholar 

  23. Mezrich JD, Pirsch JD, Fernandez LA, et al. Differential outcomes of expanded-criteria donor renal allografts according to recipient age. Clin J Am Soc Nephrol. 2012;7:1163–71.

    Article  Google Scholar 

  24. Ojo AO, Hanson JA, Meier-Kriesche H, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001;12:589–97.

    CAS  PubMed  Google Scholar 

  25. Arrieta J. Evaluación económica del tratamiento sustitutivorenal (hemodiálisis, diálisis peritoneal y trasplante) en España. Nefrologia. 2010;1(Supl Ext 1):37–47.

    Google Scholar 

  26. Singbartl K, Murugan R, Kaynar AM, et al. Intensivist-led management of brain-dead donors is associated with an increase in organ recovery for transplantation. Am J Transplant. 2011;11:1517–21.

    Article  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Avda Valdecilla, s/n., 39008, Santander, Spain

    María Ángeles Ballesteros MD, PhD, Borja Suberviola MD, PhD & Eduardo Miñambres MD, PhD

  2. Department of Nephrology, Hospital Marqués de Valdecilla, IDIVAL. REDinREN RD16/0009/0027, Avda Valdecilla, s/n., 39008, Santander, Spain

    Lara Belmar Vega MD & Juan Carlos Ruiz San Millán MD, PhD

  3. Service of General Surgery, University Hospital Marqués de Valdecilla-IDIVAL, Avda Valdecilla, s/n., 39008, Santander, Spain

    Roberto Fernández-Santiago MD

  4. Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Avda Valdecilla, s/n., 39008, Santander, Spain

    Sandra Campos Fernández MD

  5. School of Medicine, University of Cantabria, Santander, Spain

    Eduardo Miñambres MD, PhD

Authors
  1. María Ángeles Ballesteros MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Borja Suberviola MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lara Belmar Vega MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberto Fernández-Santiago MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandra Campos Fernández MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Juan Carlos Ruiz San Millán MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eduardo Miñambres MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to María Ángeles Ballesteros MD, PhD.

Ethics declarations

Conflict of interest

M.Á. Ballesteros, B. Suberviola, L. Belmar-Vega, R. Fernández-Santiago, S. Campos Fernández, J.C. Ruiz San Millán, and E. Miñambres have no conflicts of interest to disclose

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ballesteros, M.Á., Suberviola, B., Belmar Vega, L. et al. Impact of the elderly donor on an abdominal organ transplantation program. Eur Surg 52, 223–228 (2020). https://doi.org/10.1007/s10353-020-00637-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10353-020-00637-0

Keywords

Search

Navigation