Başkent Üniversitesi Yayınları

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    Orthotopic Liver Transplant Using Allografts From Geriatric Population in the United States: Is There Any Age Limit?
    (Başkent Üniversitesi, 2010-09) Singhal, Ashish; Jabbour, Nicolas; Cho, Yong W.; Hutchinson, Lan V.; Ghuloom, Adel E.; Sezginsoy, Banu
    Objectives: Observations of minimal patho­physiological changes in the liver with healthy aging represent the rationale for expanding the donor pool with older donors. However, a debate exists for their upper age limit. The aim of this study is to examine the outcomes of orthotopic liver transplants from older patients (≥ 60 years). Materials and Methods: Using the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) data, we retrospectively analyzed graft and patient survivals of orthotopic liver transplants done with octogenarian grafts (n=197) and compared them with orthotopic liver transplants done with donors aged between 60 and 79 years (n=4003) and < 60 years (n=21 290) during 2003 to 2007. Results: One- and 3-year graft and patient survival rates among recipients of hepatic allografts from donors < 60 years of age were significantly superior to recipients of octogenarian grafts (graft: 84% vs 75.5% at 1 year; 74.2% vs 61.2% at 3 years; P < .001; patient: 87.8% vs 81.0% at 1-year; 79.3% vs 69.1% at 3 years; P < .001). However, there was no survival difference between recipients of allografts from donors aged > 80 years and 60-79 years (graft: 75.5% vs 77.4% at 1 year; 61.2% vs 64.2% at 3 years; P = .564; patient: 81.0% vs 83.8% at 1 year; 69.1% vs 71.8% at 3 years; P = .494). It correlates well with hepatitis C virus-seronegativity and relatively lower model for end-stage liver disease score among recipients of octogenarian grafts (P < .001). Conclusions: Careful donor evaluation, avoidance of additional donor risk factors, and their pairing with appropriate recipients offer acceptable functional recovery, even with donors > 80 years.
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    Risk Factors for Delayed Graft Function Defined as Need for Dialysis or Failure of Creatinine to Fall by 10% in the First 24 Hours After Transplant
    (Başkent Üniversitesi, 2008-03) Stratopoulos, Charalabos; Friend, Peter J.; Sinha, Sanjay; Vaidya, Anil; Muthusamy, Anand; Zilvetti, Miguel; Brockmann, Jens; Roberts, Ian S. D.
    Objectives: Delayed graft function after deceased-donor transplant remains a significant clinical problem. The conventional definition of delayed graft function is the requirement of dialysis within the first week after transplant, but this criterion has many problems that have led to many controversies including those of incidence and significance. Therefore, we sought to identify the possible risk factors of delayed graft function and to investigate their effect on short-term graft survival, according to a composite criterion. Materials and Methods: We reviewed the records of 94 renal transplants obtained from heart-beating deceased donors done at our center during a 2-year period. Variables related to the donor, recipient, and graft were retrospectively collected. Follow-up was 12 months. Delayed graft function was defined as the need for dialysis or the failure of the creatinine level to fall by 10% during the first 24 hours after transplant. To confirm suspected rejection, protocol biopsies were done, irrespective of graft function, on the seventh and 28th days after transplant, or when indicated to confirm suspected rejection. Results: The overall incidence of delayed graft function was 31.9%. Multivariate analysis showed donor age as a significant independent predictor of delayed graft function (OR=1.05, P = .03, 95% CI: 1.01-1.09), whereas donor hypotension was the only independent risk factor associated with a worse 1-year graft survival rate (OR=4.6, P = .021, 95% CI: 1.3-16.5). No association could be established between delayed graft function, acute rejection, and graft survival. Conclusions: Advanced donor age is a predictor of delayed graft function defined as the need for dialysis or the failure of creatinine to fall by 10% during the first 24 hours after transplant. Preventing hemodynamic instability should be an important aspect of donor care.