Use of Elderly Allografts in Liver Transplantation.

Abstract

Purpose: Use of liver allografts from elderly donors has increased due to organ shortage and increased life expectancy of the general population. The aim of this study is to evaluate the current utilization of elderly donors in the United States, patterns of recipient selection, and their outcomes. Methods: Using a linkage between the Scientific Registry of Transplant Recipients and University HealthSystem Consortium databases, we identified 12,445 liver transplant (LT) recipients between January 2007 and December 2011. Recipients were divided into two cohorts based on the donor age: ≥ 70 years (n= 540) and < 60 years (n= 10,473). A stepwise cox regression evaluated the impact of elderly donors on graft survival after adjusting for transplant related factors. Results: Elderly donors accounted for 4.3% of donors used in the five-year period. Compared to younger donors, elderly donors were more likely to be females (53.9% vs. 39.0%, P<0.001), shared regionally or nationally (46.4% vs. 28.5%, P<0.001), and used at high volume centers (48.5% vs. 32.2%, P<0.001). The top three centers using elderly donors accounted for 1/3 of all elderly donors, and resided in Regions 7 and 9. The comparison between the two recipient cohorts showed that recipients of elderly donors were older (> 60 years: 47.8% vs. 29.1%, P<0.001), less likely to be on dialysis (2.6% vs. 8.1%, P<0.001), or inpatient at time of LT (16.9% vs. 21.7%, P=0.03), and had lower MELD score (>28: 13.2% vs. 23.0%, P<0.001). Both recipient groups had similar perioperative mortality, readmission rates, and long-term patient survival. Recipients of elderly donors were associated with increased graft loss (p<0.001). In the multivariate analysis, elderly donors were associated with increased risk of graft failure only when adjusted for recipient characteristics (HR 1.32, 95% CI 1.11-1.56) or center and regional factors (HR 1.23; 95% CI 1.04-1.46) individually; however, in the adjusted analysis including all these factors together, elderly donors did not carry increased risk of graft failure. Conclusions: Currently, the use of elderly liver allografts is limited to selected recipients (older age, less severe disease) by high volume centers in regions of high wait list mortality. Adjusted analysis of graft survival confirms that the use of elderly donors in appropriately selected recipients and centers results in acceptable graft survival.