Liver Transplantation from Donors Aged 80 Years and Over: Pushing the Limit

Abstract

Older donors are a growing part of the total donor pool but no definite consensus exists on the limit of age for their acceptance. From November 1998 to January 2003, in a retrospective case-control multicenter study, we compared the outcome of 30 orthotopic liver transplantations (OLTs) with octogenarian donors and of 60 chronologically correlated OLTs performed with donors <40 years. The percentage of refusal was greater among older than younger donors (48.2 vs. 14.3%; p < 0.001). Cold ischemia was significantly shorter in the older than younger groups. Recipients with hepatocarcinoma and older age received octogenarian grafts more frequently. No differences were seen in post-operative complications and 6-month graft and patient survival. However, longterm survival was lower in patients transplanted with octogenarian donors (p = = 0.04). Interestingly, the mortality related to hepatitis C recurrence was greater in patients with octogenarian donors. Accordingly, the long-term survival of HCV-positive patients who received older grafts was lower than those receiving younger grafts (p = = 0.05). Octogenarian livers can be used safely but a careful donor evaluation and a short cold ischemia are required to prevent additional risk factors. However, hepatitis C recurrence is associated with a greater mortality in patients who received octogenarian grafts raising concerns whether to allocate these livers to HCV-positive recipients.

Liver Transplantation for Alcohol-Related Cirrhosis: A Single Centre Long-Term Clinical and Histological Follow-Up

“…This finding raises the question as to whether organs of aged donors, who would be considered unacceptable for most LT recipients, may in fact provide adequate liver function for these ALD patients. Some centres have published excellent results for donor organs up to the age of 80 years and more [19][20][21][22][23]. However, we know that organs from older donors are more susceptible to ischemia-reperfusion injury, and these grafts do worse in patients with high MELD scores [24][25][26].…”

Matching donor to recipient in liver transplantation: Relevance in clinical practice

“…In a retrospective review of 111 patients transplanted for hepatitis C related CLD, Rayhill et al [11] reported that grafts from donors over 60 years of age were associated with severe recurrent HCV. Several authors have suggested that these should be avoided in HCV recipients [12,13] . Despite these issues, older donors remain a valuable source of organs [14][15][16] .…”

Deceased donor risk factors influencing liver transplant outcome

“…More recent reports analyzing large transplant registries have confirmed the animal models [1,2], livers from older donors do not seem to recover from damage as rapidly or completely as those from younger donors. Nonetheless, there are also many smaller studies reporting excellent results using liver grafts from donors in their 70s [3,4] or even in selected donors greater than 80 years old [5,6]. These results with older donors highlight the fact that both donor and recipient factors contribute to long-term results and that utilizing organs from older donors must be weighed in the context of all the risks candidates face waiting.…”