Utilization of elderly donors in living donor liver transplantation

When more is less?

Murat Dayangac, C. Burcin Taner, Onur Yaprak, Tolga Demirbas, Deniz Balci, Cihan Duran, Yildiray Yuzer, Yaman Tokat

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

An accepted definition of donor exclusion criteria has not been established for living donor liver transplantation (LDLT). The use of elderly donors to expand the living donor pool raises ethical concerns about donor safety. The aims of this study were (1) the comparison of the postoperative outcomes of living liver donors by age (≥50 versus <50 years) and (2) the evaluation of the impact of the extent of right hepatectomy on donor outcomes. The study group included 150 donors who underwent donor right hepatectomy between October 2004 and April 2009. Extended criteria surgery (ECS) was defined as right hepatectomy with middle hepatic vein (MHV) harvesting or right hepatectomy resulting in an estimated remnant liver volume (RLV) less than 35%. The primary endpoints were donor outcomes in terms of donor complications graded according to the Clavien classification. Group 1 consisted of donors who were 50 years old or older (n = 28), and group 2 consisted of donors who were less than 50 years old (n = 122). At least 1 ECS criterion was present in 74% of donors: 57% had 1 criterion, and 17% had 2 criteria. None of the donors had grade 4 complications or died. The overall and major complication rates were similar in the 2 donor age groups [28.6% and 14.3% in group 1 and 32% and 8.2% in group 2 for the overall complication rates (P = 0.8) and the major complication rates (P = 0.2), respectively]. However, there was a significant correlation between the rate of major complications and the type of surgery in donors who were 50 years old or older. In LDLT, extending the limits of surgery comes at the price of more complications in elderly donors. Right hepatectomy with MHV harvesting and any procedure causing an RLV less than 35% should be avoided in living liver donors who are 50 years old or older.

Original languageEnglish (US)
Pages (from-to)548-555
Number of pages8
JournalLiver Transplantation
Volume17
Issue number5
DOIs
StatePublished - May 2011

Fingerprint

Living Donors
Liver Transplantation
Tissue Donors
Hepatectomy
Hepatic Veins
Liver
Donor Selection

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology

Cite this

Dayangac, M., Taner, C. B., Yaprak, O., Demirbas, T., Balci, D., Duran, C., ... Tokat, Y. (2011). Utilization of elderly donors in living donor liver transplantation: When more is less? Liver Transplantation, 17(5), 548-555. https://doi.org/10.1002/lt.22276

Utilization of elderly donors in living donor liver transplantation : When more is less? / Dayangac, Murat; Taner, C. Burcin; Yaprak, Onur; Demirbas, Tolga; Balci, Deniz; Duran, Cihan; Yuzer, Yildiray; Tokat, Yaman.

In: Liver Transplantation, Vol. 17, No. 5, 05.2011, p. 548-555.

Research output: Contribution to journalArticle

Dayangac, M, Taner, CB, Yaprak, O, Demirbas, T, Balci, D, Duran, C, Yuzer, Y & Tokat, Y 2011, 'Utilization of elderly donors in living donor liver transplantation: When more is less?', Liver Transplantation, vol. 17, no. 5, pp. 548-555. https://doi.org/10.1002/lt.22276
Dayangac M, Taner CB, Yaprak O, Demirbas T, Balci D, Duran C et al. Utilization of elderly donors in living donor liver transplantation: When more is less? Liver Transplantation. 2011 May;17(5):548-555. https://doi.org/10.1002/lt.22276
Dayangac, Murat ; Taner, C. Burcin ; Yaprak, Onur ; Demirbas, Tolga ; Balci, Deniz ; Duran, Cihan ; Yuzer, Yildiray ; Tokat, Yaman. / Utilization of elderly donors in living donor liver transplantation : When more is less?. In: Liver Transplantation. 2011 ; Vol. 17, No. 5. pp. 548-555.
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abstract = "An accepted definition of donor exclusion criteria has not been established for living donor liver transplantation (LDLT). The use of elderly donors to expand the living donor pool raises ethical concerns about donor safety. The aims of this study were (1) the comparison of the postoperative outcomes of living liver donors by age (≥50 versus <50 years) and (2) the evaluation of the impact of the extent of right hepatectomy on donor outcomes. The study group included 150 donors who underwent donor right hepatectomy between October 2004 and April 2009. Extended criteria surgery (ECS) was defined as right hepatectomy with middle hepatic vein (MHV) harvesting or right hepatectomy resulting in an estimated remnant liver volume (RLV) less than 35{\%}. The primary endpoints were donor outcomes in terms of donor complications graded according to the Clavien classification. Group 1 consisted of donors who were 50 years old or older (n = 28), and group 2 consisted of donors who were less than 50 years old (n = 122). At least 1 ECS criterion was present in 74{\%} of donors: 57{\%} had 1 criterion, and 17{\%} had 2 criteria. None of the donors had grade 4 complications or died. The overall and major complication rates were similar in the 2 donor age groups [28.6{\%} and 14.3{\%} in group 1 and 32{\%} and 8.2{\%} in group 2 for the overall complication rates (P = 0.8) and the major complication rates (P = 0.2), respectively]. However, there was a significant correlation between the rate of major complications and the type of surgery in donors who were 50 years old or older. In LDLT, extending the limits of surgery comes at the price of more complications in elderly donors. Right hepatectomy with MHV harvesting and any procedure causing an RLV less than 35{\%} should be avoided in living liver donors who are 50 years old or older.",
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