Use of octogenarian donors for liver transplantation: A survival analysis

Abstract

Use of very old donors in liver transplantation (LT) is controversial because advanced donor age is associated with a higher risk for graft dysfunction and worse long-term results, especially for hepatitis C virus (HCV)-positive recipients. This was a retrospective, single-center review of primary, ABO-compatible LT performed between 2001 and 2010. Recipients were stratified in four groups based on donor age (<60 years; 60-69 years; 70-79 years and ≥80 years) and their outcomes were compared. A total of 842 patients were included: 348 (41.3%) with donors <60 years; 176 (20.9%) with donors 60-69 years; 233 (27.7%) with donors 70-79 years and 85 (10.1%) with donors ≥80 years. There was no difference across groups in terms of early (≤30 days) graft loss, and graft survival at 1 and 5 years was 90.5% and 78.6% for grafts <60 years; 88.6% and 81.3% for grafts 60-69 years; 87.6% and 75.1% for grafts 70-79 years and 84.7% and 77.1% for grafts ≥80 years (p=0.065). In the group ≥80 years, the 5-year graft survival was lower for HCV-positive versus HCV-negative recipients (62.4% vs. 85.6%, p=0.034). Based on our experience, grafts from donors ≥80 years may provide favorable results but require appropriate selection and allocation policies. The authors illustrate their experience with use of octogenarian donors for liver transplantation, highlighting the risk factors for graft loss and showing that accurate donor evaluation and appropriate donor-to-recipient matching are key to favorable long-term results. See editorial by Lai et al on page 1962. © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.