Liver transplant using octogenarian donors

Abstract

We read with interest the article from Ghinolfi et al. (1) about the risk of ischemic-type biliary lesions using octogenarian grafts. In this study, the authors show favorable results with accurately selected very old donors.In Europe, life expectancy has risen at a steady pace of 2.5 years per decade for a century and a half, (2,3) piercing inexorably all the life-span ceilings predicted over time by scientists, and nowadays, the ultimate limit to human age is unforeseeable. If death occurs in increasingly older individuals, it is reasonable to expect deceased donor age to rise as well. In accordance with this hypothesis, Ghinolfi et al. (4) report that liver transplantations (LTs) from octogenarian donors increased constantly between 2001 (3.5%) and 2010 (16.1%); this result is consistent with data from Spain (5) and from the European Liver Transplant Registry. (6) In our series (1571 liver transplants performed between December 1985 and December 2015), the first LT with an octogenarian donor was in 2002; in 2015, 11% of LTs were performed with octogenarian grafts. The mean and median donor age increased significantly (P < 0.001 for both) in an exquisitely linear manner (r 2 5 0.97 and 0.93 respectively; slope 5 1.27 [95% confidence interval (CI), 1.19-1.35] and 1.50 [95% CI, 1.35-1.65], respectively; Fig. 1), reaching the current value of 60.7 and 62 years, respectively. According to this model, we will reach the donor median age of 80 years in 1 decade (9.92 years; 95% CI, 6.28-14.34), meaning that in 2025 the majority of LTs could be performed with a graft aged 80 years or more (Fig. 1).Furthermore in the current decade, the control over HCV infection (an independent predictor of poor survival in transplants from octogenarian grafts (4) ) may lessen concerns on accepting and allocating very old grafts thus increasing their use.In conclusion, we thank Ghinolfi et al.(1) for the precious research they are carrying on, and we encourage other groups to share their experience on octogenarian liver grafts.

Usefulness of T-Tube in Liver Transplantation: Still Effective or Outmoded Strategy?

“…These features are currently accepted more and more often in an effort to fill the gap between available organs and patients on the waitlist [4]. Particularly, a linear increase in donor age has been observed, which could nonetheless be associated with a higher risk of ischemic-type biliary lesions [5,6].…”