Optimization of long-term graft survival after liver transplantation: the role of donor age

Abstract

Background: Nowadays, several solutions have been proposed for the minimization of either organ shortage and long waiting time: Expansion of donor pool using aged donors represents a possible solution. However, it is not completely clear if use of "extreme" donors could cause inacceptable posttransplant adjunctive risks. The aim of this study is to evaluate the impact of donor age on long-term graft survival. Materials and methods: From January 2001 to April 2009, 188 consecutive liver transplantation were performed at our Department. The entire cohort was stratified in 4 subgroups according to donor age: Group 1 (1st-2nd decade, n=34), Group 2 (3rd-4th, n=51), Group 3 (5th-6th, n=75) and Group 4 (7th-8th, n=28). Donor, recipient and transplantation characteristics were compared in the 4 groups. Results: D: Onor age, percentage of cerebrovascular deaths, BMI and DRI resulted higher in the last group. Male gender was prevalent in the 1st Group, while macrovescicular steatosis resulted higher in the 3rd Group. Recipient and immediate post-transplant features resulted homogeneous among the groups. At survival analysis, 5-year graft survival rates resulted progressively worsened among the groups (82.4 vs 73.3 vs 64.7 vs 39.6%, respectively). Statistical significance was observed between the first 2 Groups and 4th one (p-value 0.003 and 0.006, respectively), while a boundary statistical significance was observed between 1st and 3rd Group. Conclusions: In our experience, use of < 70 year-aged donors seems to be safe, while very aged (over 70) donors give poor long-term survivals, despite similar initial post-transplantation results. We could speculate that grafts procured by very aged donors could be easier targets of viral recurrence, late ischemia-reperfusion damage and chronic rejection. A better allocation system for these organs may be improved, preferring HCC recipients who exceed transplants criteria to HCV ones.