Outcomes of deceased donor liver transplantation from elderly donors

Abstract

Favorable outcomes achieved after deceased donor liver transplantation (DDLT) suggest that use of elderly donors may be an effective way to expand donor pool. This was a retrospective analysis of adult DDLT using elderly donors. It was a double-arm study that compared posttransplant outcomes to ascertain whether use of elderly donors (aged ≥76 years) has adverse effects on outcome of DDLT. The elderly study group included 14 donors aged ≥76 years and the elderly control group comprised 39 donors aged 66-75 years. Mean age of the elderly and control groups was 78.2 ± 3.1 years and 68.9 ± 2.7 years, respectively (p < 0.001). Other clinical parameters were comparable between these two groups. The 1-, 3-, and 5-year graft survival rates in the elderly study group were 83.6%, 59.7%, and 59.7%, respectively, and those in the elderly control group were 79.4%, 68.1%, and 59.6%, respectively (p = 0.97). The overall 1-, 3-, and 5-year survival rates after donation from the elderly study group were 83.6%, 59.7%, and 59.7%, respectively, and those after donation from the control group were 79.3%, 72.1%, and 64.1%, respectively (p = 0.74). Regarding overall patient survival, univariate analysis identified pretransplant requirement for ventilator support (p = 0.021) and pretransplant renal replacement therapy (p = 0.025) as statistically significant risk factors; however, neither was significant on multivariate analysis. The data suggest that organs from elderly donors do not worsen posttransplant outcomes; thus, advanced age should not be an exclusion criteria criterion. Indeed, using such donors could be the key to increasing the supply of liver grafts.