Septuagenarian and octogenarian Donors Provide Excellent Liver Grafts for Transplantation

Background.
Wider utilization of liver grafts from donors
70 years old could substan-
tially expand the organ pool, but their use remains limited by fear of poorer outcomes. We
examined the results at our center of liver transplantation (OLT) using livers from donors
70 years old.
Methods.
From February 2003 to August 2010, we performed 450 OLT including 58
(13%) using donors
70 whose outcomes were compared with those using donors
70
years old.
Results.
Cerebrovascular causes of death predominated among donors
70 (85% vs
47% in donors
70;
P
.001). In contrast, traumatic causes of death predominated among
donors
70 (36% vs 14% in donors
70;
P
.002). Unlike grafts from donors
70 years
old, grafts from older individuals had no additional risk factors (steatosis, high sodium, or
hemodynamic instability). Both groups were comparable for cold and warm ischemia
times. No difference was noted in posttransplant peak transaminases, incidence of primary
nonfunction, hepatic artery thrombosis, biliary strictures, or retransplantation rates
between groups. The 1- and 5-year patient survivals were 88% and 82% in recipients of
livers
70 versus 90% and 84% in those from
70 years old (
P
.705). Recipients of older
grafts, who were 6 years older than recipients of younger grafts (
P
.001), tended to have
a lower laboratory Model for End-Stage Liver Disease score (
P
.074).
Conclusions.
Short and mid-term survival following OLT using donors
70 yo can be
excellent provided that there is adequate donor and recipient selection. Septuagenarians and
octogenarians with cerebrovascular ischemic and bleeding accidents represent a large pool of
potential donors whose wider use could substantially reduce mortality on the OLT waiting list.