Excellent Outcomes of Deceased Donor Liver Transplantation Using Grafts From Older Donors: A U.S. Single-Center Experience

Abstract

Introduction: One of the major challenges in deceased donor liver transplantation (DDLT) is the scarcity of donor allografts, which results in high wait-list mortality. Transplant centers tackle the donor graft scarcity by utilizing expanded criteria donors including older donors. UNOS reported that the percentage of donor age > 50 years rose from 24% in 1989 to 33% in 2013. The literature on the impact of older donor age on liver graft function, survival and complications have described contradictory results. In this study, we aim to evaluate patient and graft survival outcomes of DDLT recipients in 2 groups: donor age ≥65 years and donor age < 65 years. Methods: Setting: Single center Retrospective cohort study at a large volume US liver transplant center Inclusion criteria: All primary deceased liver transplants (DDLT) in our institution between October 2012 to October 2016 Exclusion criteria: age <18, split and reduced-size livers and multi-organ transplants were excluded from the study Outcomes: Comparison of 1-year /overall patient and graft survival in 2 groups: donor age ≥65 years and donor age < 65 years. Results: In total, 646 patients met inclusion criteria. Among patients who underwent DDLT, 70 (11%) received DDLT from older (>65 years) donors. There was no difference in age, sex, ethnicity, hepatocellular carcinoma, warm/cold ischemia time, donor sex, donor ethnicity, donor BMI in both groups. Patients who received liver transplantation from donor age >65 had lower HCV infection (20% vs 41%), lower MELDNa score (19±6 vs 21±9), and lower donor HCV-positive graft (3% vs 13%) [Table 1]. Recipients of donor age ≥65 had similar outcomes including 1-year patient survival (96% vs 92%, p = NS), 1-year graft survival (93% vs 90%, p =NS), overall patient survival (94% vs 86%, p =NS) and overall graft survivals (90% vs 84%, p=NS) comparing to recipients of donor age <65, respectively [Table 2 and Figure 1].1014_A Figure 1. Baseline charecteristicsConclusion: In our study, careful allocation of grafts from older donors to appropriate recipients resulted in excellent 1-year and longer-term patient and graft survival comparable with outcomes in recipients from donor grafts age <65 years. Increasing utilization of grafts from older donors can expand the donor pool to decrease the national organ donor shortage.1014_B Figure 2. Results1014_C Figure 3. Kaplan Meier survival graphs