Long-term outcomes of the octogenarian donor liver recipient: The era of the new centurion.

Abstract

Studies have suggested transplantation using older donor livers results in similar short-term outcomes as younger donor livers; however, little data exist on long-term patient/graft outcomes of the octogenarian liver recipient. Retrospective data were collected from 2 centers, (Valencia, Spain and Rochester, MN, USA) of all recipients of octogenarian donor liver allografts from 2000 to 2011 with follow-up to 2016. The aim was to compare long-term patient/graft survival as well as metabolic outcomes of the recipient with the octogenarian liver vs younger than 60years donor. 78 recipients of older liver allografts were compared to 78 matched controls. No difference in 10-year patient mortality was demonstrated (P=0.074). Octogenarian livers were associated with 3-fold higher likelihood of graft failure (P=0.002) but no increase in the risk of post-LT cardiovascular disease (P=0.60), hypertension (P=0.33), vascular complications (P=0.53), or malignancy (P=0.14). In multivariate analysis, elder livers remained a significant factor associated with rejection (P=0.034) with a trend not reaching statistical significance for graft failure (P=0.052). For appropriately selected recipients, receiving an octogenarian liver does not clearly influence patient survival but does impact early graft survival with a notable increase in early posttransplant rejection rates and re-transplantation. Over 1.5 decades, older allografts have not adversely affected metabolic outcomes.