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INTRODUCTION The use of liver allografts from elderly donors (≥70 years) has increased because of organ shortage and increased life expectancy. The aim of this study is to evaluate the current utilization of elderly donors in United States, recipient selection, and their posttransplant outcomes. METHODS A linkage between Scientific Registry of Transplant Recipients and University HealthSystem Consortium databases was performed. Between January 2007 and December 2011, 12,445 liver transplant (LT) recipients were identified and divided into 2 cohorts based on donor age: 70 years or older (n = 540) and younger than 60 years (n = 10,473). RESULTS Elderly donors accounted for 4.3% of all donors used in the 5-year period. When compared to younger donors, elderly donors were more likely to be women, shared regionally or nationally, and used at higher volume centers. Elderly donor allografts were less likely to be used in recipients with model of end-stage liver disease score higher than 27 (13.2% vs. 23.0%, P < 0.001), hospitalized (16.8% vs. 21.7%, P = 0.03), or on hemodialysis at time of transplant (2.6% vs. 8.2%, P < 0.001). Both recipient groups had similar perioperative mortality, 30-day readmission rates, and short-term patient survival. In the multivariate analysis, including recipient, donor, center and regional factors, donor age 70 years or older was associated with slightly increased risk of graft loss (hazard ratio, 1.3; 95% confidence interval, 1.08-1.56; P = 0.005). CONCLUSIONS The current trend toward the use of elderly donors in liver transplant recipients with low model of end-stage liver disease scores (

Background Metabolic syndrome is increasing among patients undergoing liver transplantation. Nonalcoholic steatohepatitis is a manifestation of metabolic syndrome and is an increasingly common cause of end-stage liver disease necessitating orthotopic liver transplantation. We sought to determine the effect of preoperative risk factors on the development of post-transplant metabolic syndrome, complications, readmissions, and mortality. Methods We conducted a review of 114 orthotopic liver transplantations at our institution from May 2012 to April 2014. Results Patients with (n = 19) and without (n = 95) metabolic syndrome were similar with regard to age, race, and model for end-stage liver disease at time of transplant. Donor and operative factors also were similar between the groups. Preoperative diabetes was found to be associated with an increased rate of readmission (odds ratio 3.45, P = .03). While preoperative metabolic syndrome itself was not a significant predictor of worse outcomes, postoperative metabolic syndrome was associated with significantly greater readmissions in the first year. Major predictors of new onset metabolic syndrome after orthotopic liver transplantation included preoperative diabetes and obesity (odds ratio 8.54 and odds ratio 5.49, P Conclusion Efforts to decrease the incidence of postoperative metabolic syndrome after orthotopic liver transplantation may decrease readmissions and improve outcomes, along with decreasing resource utilization.

The results of simultaneous liver-kidney transplants in highly sensitized recipients have been controversial in terms of antibody-mediated rejection and kidney allograft outcomes. This case report provides a detailed and sophisticated documentation of histocompatibility and pathologic data in a simultaneous liver-kidney transplant performed in a recipient with multiple high-titered class I and II antidonor HLA antibodies and a strongly positive cytotoxic crossmatch. Patient received induction with steroids, rituximab, and eculizumab without lymphocyte depleting agents. The kidney transplant was delayed by 6 hours after the liver transplant to allow more time to the liver allograft to “absorb” donor-specific antibodies (DSA). Interestingly, the liver allograft did not prevent immediate antibody-mediated injury to the kidney allograft in this highly sensitized recipient. Anti-HLA single antigen bead analysis of liver and kidney allograft biopsy eluates revealed deposition of both class I and II DSA in both liver and kidney transplants during the first 2 weeks after transplant. Afterward, both liver and kidney allograft functions improved and remained normal after a year with progressive reduction in serum DSA values.

Aim A wait listed patient was HLA serologically phenotyped at the A,B,DR, and DR53 locus in 3/2002. The patient subsequently received a UNOS defined zero antigen mismatch (zero mismatch is no HLA mismatch antigens at the A,B,DR locus) kidney transplant in 12/2003. The donor was HLA typed by serology for A,B,DR,DR51,DR53, and DQ locus. The patient presented with rejection in 2/2011. Solid phase single antigen testing on the Luminex detected no DSA for the known HLA donor antigens. However, HLA antibody was identified for two DP antigens (DPB1∗02 and ∗13). The HLA antibody persisted through rejection treatment. To eliminate the DP antibodies as being DSA, HLA phenotyping was performed on a renal allograft biopsy sample using real time PCR (qPCR). The patient’s molecular HLA typing was performed with rSSO. Methods The laboratory obtained a frozen section of the renal allograft biopsy from 9/2012. DNA was extracted using a DNA tissue kit. Molecular HLA typing was performed using qPCR. Results Recipient and donor HLA phenotype results are presented in the table:[figure1]The qPCR HLA typing of the biopsy sample obtained DPB1∗0301 and 0401 alleles, identical to the recipient’s DPB1 alleles. Conclusions qPCR for HLA typing presents the opportunity to provide an extensive HLA typing of historical organ donors, especially when there is incomplete HLA donor phenotyping. This is of particular importance because zero antigen mismatch donors can be mismatched at additional loci (DQB1, DPB1, etc.) not considered by UNOS criteria for zero mismatch. DSA identification is an important component in diagnosing patients with allograft rejection. In this case, we were able to determine that DSA was not present.