Organ Transplantation Research Today is a free monthly online journal that collates and summarizes the latest research about Organ Transplantation, including details on risks, prognosis, procedure, surgery.

Advanced recipient age (>60 years) alone should not be a contraindication to liver retransplantation.

Schmitt TM, Kumer SC, Pruett TL, Argo CK, Northup PG

Department of Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA. tms4h@virginia.edu

Advanced age has been shown to be a risk factor for survival in primary liver transplantation. We sought to determine the independent influence of recipient age on retransplantation survival. The UNOS dataset was analyzed for adult, nonstatus 1, liver retransplantations since February 27, 2002. The univariate effect of age on 90-day and 1-year survival was analyzed. Multivariate survival models were used to determine 90-day, 1-year, and overall survival. Recipient age, donor age, model for end-stage liver disease (MELD) score, and hepatitis C status were used to construct multivariable survival models. Some 2141 liver retransplantations were analyzed. Overall, increasing recipient age was independently predictive of increasing mortality after liver retransplantation. In recipients between 18 and 60, there remained a direct relationship between age and mortality. However, in recipients aged over 60, increasing age was not independently associated with 90-day mortality (P = 0.88) and 1-year mortality (P = 0.74), despite adjusting for donor age, MELD score, and viral hepatitis status, suggesting that their original liver condition, their co-morbidities or perioperative condition plays an important role in retransplantation survival. Increasing recipient age up to 60, adversely affects liver retransplantation survival. After 60, there are no additional risks. Advanced age alone should not be an exclusionary factor when considering liver retransplantation; only the overall ability of the patient to tolerate a major surgery should be the determining factor.

Published 3 June 2009 in Transpl Int, 22(6): 601-5.
Full-text of this article is available online (may require subscription).

Articles on Organ Transplantation published 3 June 2009:

Chronologically different incidences of post-transplant malignancies in renal transplant recipients: single center experience.   Transpl Int, 22(6): 644-53.

The incidence of malignancy in transplant recipients is known to be higher than the same in the general population. However, the types of malignancies vary geographically, and the relative risks (RR) for malignancy in transplant recipients, compared with that of the general population, also differ country-by-country. In this study, we investigated the incidence and characteristics of malignancies after renal transplantation in a single center. A total of 2630 renal recipients who underwent ... [Abstract] [Full-text]

Predictors of psychological morbidity in liver transplant assessment candidates: is alcohol abuse or dependence a factor?   Transpl Int, 22(6): 606-14.

Orthotopic liver transplantation candidates with depressive and other symptoms report poorer perceived quality of life when compared with nondepressed patients, and are also significantly more likely to die while awaiting transplantation. Alcohol abuse and dependence have been associated with increased levels of psychological co-morbidity. This article presents data about psychological morbidity from a prospective study of patients being assessed for liver transplantation in Birmingham, UK, and ... [Abstract] [Full-text]

Commercial transplants in local Pakistanis from vended kidneys: a socio-economic and outcome study.   Transpl Int, 22(6): 615-21.

Donor shortage and absence of transplant law lead to unrelated commercial transplants in Pakistan. We report the socio-economic and outcome parameters of 126 local recipients of unrelated kidney vendor transplants presenting to our institute between 1997 and 2007. Their outcome was compared with 180 recipients of living-related donor transplants matched for age, gender and transplant duration as controls. Age of commercial recipients was 35.63 +/- 11.57 years with an M:F ratio of 2.4:1. ... [Abstract] [Full-text]

Treatment for BK virus: incidence, risk factors and outcomes for kidney transplant recipients in the United States.   Transpl Int, 22(6): 626-34.

There has been a notable rise of BK virus among kidney transplant recipients. Single-center reports have identified risk factors for development of BK virus. However, there has not been an assessment of risk factors and incidence of this complication at a national level. This study utilized newly collected follow-up information from the national SRTR database to investigate incidence, risk factors and outcomes for solitary kidney transplant recipients associated with treatment for BK virus ... [Abstract] [Full-text]

Tacrolimus and mycophenolate mofetil as first line immunosuppression after lung transplantation.   Transpl Int, 22(6): 635-43.

The optimal maintenance therapy after lung transplantation remains to be established. The aim of this study was to analyse the impact of tacrolimus and mycophenolate mofetil (MMF) as first line immunosuppression on long-term survival and Bronchiolitis Obliterans Syndrome (BOS). From January 1996 through December 2006, all 155 recipients receiving tacrolimus and MMF as maintenance immunosuppression were included in this study. Tacrolimus and MMF was discontinued in 36 patients (23.2%). The ... [Abstract] [Full-text]

Intestinal reconstruction of the lower urinary tract as a prerequisite for renal transplantation.   BJU Int, 103(11): 1555-60.

OBJECTIVE To report a two-stage protocol for children in whom bladder reconstruction was followed by kidney transplantation, as about a quarter of children requiring a kidney transplantation show significant lower urinary tract dysfunction, and consequently their bladder is unsuitable for a kidney transplant. PATIENTS AND METHODS Twelve children (median age 9.5 years, range 4.2-16.8) with end-stage renal disease had a lower urinary tract reconstruction before kidney transplantation. The cause ... [Abstract] [Full-text]

Articles on Organ Transplantation published 1 June 2009:

ABCB1 genotypes predict cyclosporine-related adverse events and kidney allograft outcome.   J Am Soc Nephrol, 20(6): 1404-15.

Cyclosporine A (CsA) is a substrate of P-glycoprotein, an efflux transporter encoded by the ABCB1 gene. Compared with carriers of the wild-type gene, carriers of T allelic variants in exons 21 or 26 have reduced P-glycoprotein activity and, secondarily, increased intracellular concentration of CsA; therefore, carriers of T variants might be at increased risk for CsA-related adverse events. We evaluated the associations between ABCB1 genotypes (in exons 12, 21, and 26) and CsA-related outcomes ... [Abstract] [Full-text]

Daclizumab versus antithymocyte globulin in high-immunological-risk renal transplant recipients.   J Am Soc Nephrol, 20(6): 1385-92.

Nondepleting anti-CD25 monoclonal antibodies (daclizumab) and depleting polyclonal antithymocyte globulin (Thymoglobulin) both prevent acute rejection, but these therapies have not been directly compared in a high-risk, HLA-sensitized renal transplant population. We randomly assigned 227 patients, who were about to receive a kidney graft from a deceased donor, to either Thymoglobulin or daclizumab if they met one of the following risk factors: current panel reactive antibodies (PRA) >30%; ... [Abstract] [Full-text]

© 2004-2009 Organ Transplantation Research Today. All Rights Reserved.