Abstract
Background & Aims
We investigate the effects of advancing donor age on the prognostic outcomes of patients
with NASH who undergo liver transplant (LT), with a specialized attention toward infectious
outcomes post-LT.
Methods
The UNOS-STAR registry was used to select 2005 to 2019 LT recipients with NASH, who
were stratified by donor age into the following categories: recipients with younger
donors (less than 50 years of age–reference), quinquagenarian donors, sexagenarian
donors, septuagenarian donors, and octogenarian donors. Cox regression analyses were
conducted for all-cause mortality, graft failure, infectious causes of death.
Results
From a total of 8888 recipients, the quinquagenarian, septuagenarian, and octogenarian
donor cohorts showed greater risk of all-cause mortality (quinquagenarian: aHR 1.16
95%CI 1.03–1.30; septuagenarian: aHR 1.20 95%CI 1.00–1.44; octogenarian: aHR 2.01
95%CI 1.40–2.88). With advancing donor age, there was an increased risk of death from
sepsis (quinquagenarian: aHR 1.71 95% CI 1.24–2.36; sexagenarian: aHR 1.73 95% CI
1.21–2.48; septuagenarian: aHR 1.76 95% CI 1.07–2.90; octogenarian: aHR 3.58 95% CI
1.42–9.06) and infectious causes (quinquagenarian: aHR 1.46 95% CI 1.12–1.90; sexagenarian:
aHR 1.58 95% CI 1.18–2.11; septuagenarian: aHR 1.73 95% CI 1.15–2.61; octogenarian:
aHR 3.70 95% CI 1.78–7.69).
Conclusion
NASH patients who receive grafts from elderly donors exhibit higher risk of post-LT
mortality, especially due to infection.
Keywords
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References
- Metabolic inflammation as an instigator of fibrosis during non-alcoholic fatty liver disease.World J Gastroenterol. 2020; 26: 1993-2011
- Liver fibrosis in non-alcoholic fatty liver disease: from liver biopsy to non-invasive biomarkers in diagnosis and treatment.Front Med. 2021; 8615978
- Hepatic fibrogenesis: the puzzle of interacting cells, fibrogenic cytokines, regulatory loops, and extracellular matrix molecules.Z Gastroenterol. 1992; 30 Suppl 1: 5-16
- Interactions between extracellular matrix and growth factors in wound healing.Wound Repair Regen. 2009; 17: 153-162
- Extracellular matrix remodeling regulates glucose metabolism through TXNIP destabilization.Cell. 2018; 175 (e21): 117-132
- Regression of portal hypertension: underlying mechanisms and therapeutic strategies.Hepatol Int. 2021; 15: 36-50
- Prognostic indicators of survival in patients with compensated and decompensated cirrhosis.Liver Int. 2012; 32: 1407-1414
- Integration of palliative care in end-stage liver disease and liver transplantation.J Palliat Med. 2014; 17: 1271-1277
- Timing and benefit of liver transplantation in acute liver failure.J Hepatol. 2014; 60: 663-670
- Increased risk of death in first year after liver transplantation among patients with nonalcoholic steatohepatitis vs liver disease of other etiologies.Clin Gastroenterol Hepatol. 2019; 17 (e5): 2759-2768
- Impact of renal impairment on cardiovascular disease mortality after liver transplantation for nonalcoholic steatohepatitis cirrhosis.Liver Int. 2015; 35: 2575-2583
- Post-transplantation outcome in non-alcoholic steatohepatitis cirrhosis: comparison with alcoholic cirrhosis.Ann Hepatol. 2019; 18: 855-861
- Impact of donor age on recipient survival in adult-to-adult living-donor liver transplantation.Ann Surg. 2018; 267: 1126-1133
Cuervas-Mons V., de la Rosa G., Pardo F., San Juan F., Valdivieso A., en representación del Registro Español de Trasplante Hepático. [Activity and results of liver transplantation in Spain during 1984-2012. Analysis of the Spanish Liver Transplant Registry]. Med Clin . 2015;144(8):337–47.
- Advanced donor age alone does not affect patient or graft survival after liver transplantation.J Am Coll Surg. 2008; 207: 847-852
- Donor age affects fibrosis progression and graft survival after liver transplantation for hepatitis C.Transplantation. 2004; 77: 84-92
- Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C.Gut. 2002; 51: 248-252
- Impact of donor age on liver transplant outcomes in patients with hepatocellular carcinoma: analysis of the SRTR database.BMC Gastroenterol. 2021; 21: 195
- Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in young adults in the United States.J Clin Gastroenterol. 2018; 52: 339-346
- Macrophages in the aging liver and age-related liver disease.Front Immunol. 2018; 9: 2795
- A proportional hazards model for the subdistribution of a competing risk.J Am Stat Assoc. 1999; 94: 496-509
Pantanowitz A., Marwala T. Evaluating the Impact of Missing Data Imputation through the use of the Random Forest Algorithm. arXiv [statME]. Published online December 12, 2008.
- Orthotopic liver transplantation in high-risk patients.Transplantation. 1998; 65: 499-504
- Trends in liver disease etiology among adults awaiting liver transplantation in the United States, 2014-2019.JAMA Netw Open. 2020; 3e1920294
- Hallmarks of aging in the liver.Comput Struct Biotechnol J. 2019; 17: 1151-1161
- Influence of aging on Kupffer cell respiratory activity in relation to particle phagocytosis and oxidative stress parameters in mouse liver.Redox Rep. 2001; 6: 155-159
- Endocytosis of soluble IgG immune complex and its transport to lysosomes in hepatic sinusoidal endothelial cells.J Hepatol. 1992; 16: 106-114
- Role of Kupffer cells in host defense and liver disease.Liver Int. 2006; 26: 1175-1186
- Effects of aging on liver microcirculatory function and sinusoidal phenotype.Aging Cell. 2018; 17: e12829
- Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection.Liver Transpl. 2012; 18: 716-726
- Improved survival in liver transplant recipients receiving prolonged-release tacrolimus in the European Liver Transplant Registry.Am J Transplant. 2015; 15: 1267-1282
- Cyclosporine A-based immunotherapy in adult living donor liver transplantation: accurate and improved therapeutic drug monitoring by 4-hr intravenous infusion.Transplantation. 2011; 92: 100-105
- 12-month follow-up analysis of a multicenter, randomized, prospective trial in de novo liver transplant recipients (LIS2T) comparing cyclosporine microemulsion (C2 monitoring) and tacrolimus.Liver Transpl. 2006; 12: 1464-1472
- Prospective or retrospective: what's in a name?.BMJ. 1991; 302: 249-250
- Recipient age and mortality after liver transplantation: a population-based cohort study.Transplantation. 2018; 102: 2025-2032
Article info
Publication history
Published online: February 15, 2023
Accepted:
January 25,
2023
Received:
July 18,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
