Impact of elderly donors for liver transplantation: A single‐center experience

Abstract

Elderly donor grafts for liver transplantation (LT) are recognized to be marginal grafts. The present study investigated the impact of using elderly donors for LT. Between June 1990 and August 2012, 1631 patients received LT at Kyoto University Hospital. Out of 1631 patients, 1597 patients received living donor liver transplantation (LDLT), whereas the other 34 patients underwent deceased donor liver transplantation (DDLT). Seventy-five grafts that were used came from individuals who were 60 years old. We retrospectively analyzed the recipients' survival rates according to donor age. The overall survival rates of the recipients of all LDLT (P < 0.001), adult-to-adult LDLT (P 5 0.007), all DDLT (P 5 0.026), and adult-to-adult DDLT (P 5 0.011) were significantly lower for the elderly donor group versus the younger group and especially for those who were hepatitis C-positive. A multivariate analysis revealed that donor age, ABO incompatibility, and preoperative intensive care unit stay were independent risk factors for poor patient survival in adult-to-adult LDLT. However, no significant differences existed between the 2 groups among those who received adult-to-adult LDLT in and after April 2006. No significant association was found between donor age and incidence of acute cellular rejection. In conclusion, donor age was closely related to the survival rate for LDLT and DDLT, although the impact of donor age was not shown in the recent cases.

Impact of younger donors on outcomes after living donor liver transplantation

“…We also reported that the overall survival rates of recipients with HCV were significantly lower after receiving grafts from elderly, ≥ 60 years old, compared with younger donors [9]. Berenguer et al reported that outcomes among HCV-positive recipients were worsened by more advanced donor age and more powerful immunosuppression [22].…”

“…On the other hand, overall survival rates did not differ in all subgroups of HCV-positive recipients who received grafts from younger and non-younger donors. For this reason, we defined donors aged < 40 years as being younger in this study, while our previous report compared overall survivals of recipients between elderly (≥ 60 years old) and non-elderly donors [9]. In fact, moreover, overall survival rates of adult-to-adult LDLT in and after April 2006 did not differ significantly between the elderly group and the younger group [9].…”

“…We previously clarified that elderly donors comprised an independent risk factor for poor survival after adult-to-adult LDLT [9]. Although grafts from younger donor are supposed to be more favorable for long-term survival, the effects of other factors are not clear.…”

“…For this reason, we defined donors aged < 40 years as being younger in this study, while our previous report compared overall survivals of recipients between elderly (≥ 60 years old) and non-elderly donors [9]. In fact, moreover, overall survival rates of adult-to-adult LDLT in and after April 2006 did not differ significantly between the elderly group and the younger group [9]. The improvement of treatments for HCV recurrence after LT might influence the finding.…”

“…We also reported that donors aged ≥ 60 years comprise an independent risk factor for poor recipient survival after LDLT [9]. On the other hand, younger donors favorably impact survival after LDLT, especially in recipients infected with hepatitis C virus (HCV) [10,11].…”