Use of octogenarian livers safely expands the donor pool.
BACKGROUND
The increasing number of recipients on the waiting list for orthotopic liver transplantation (OLT) and the scarcity of donors contribute to recipient pretransplantation mortality. One important measure to increase the donor liver pool would be to accept the previously discarded donors who are more than 80 years old.


METHODS
From November 1996 to May 1998, four liver grafts from octogenarian donors (89, 87, 82, and 85 years old, respectively) were used for OLT. Pretransplantation donor and recipient characteristics and the evolution of recipients after OLT were analyzed.


RESULTS
The donors did not present cardiac arrest or hypotension, and only low doses of vasopressors were required in three of them. Intensive care unit stay of the donors was from 12 to 24 hr. Cold ischemia time was from 4 hr to 8 hr 40 min. Mild microsteatosis was present in three donors and associated macrosteatosis of < 10% in one of these. Macroscopic appearance and consistency were normal in all four grafts. Posttransplantation evolution and follow-up were uneventful. Three recipients were alive and well at 24, 16, and 7 months; the second of these died at 16 months of recurrent viral C cirrhosis after a first OLT.


CONCLUSIONS
The liver donor pool can be increased if liver grafts are accepted without an age limit but in good condition (hemodynamic stability, short intensive care unit stay, good liver function, soft consistency, cold ischemia time <9 hr, and no severe steatosis). Octogenarian donors should be individually assessed in the absence of these ideal conditions.
Jiménez Romero
C
C
Department of General and Digestive Surgery and Organ Transplantation, Hospital Universitario Doce de Octubre, Madrid, Spain.
Moreno González
E
E
Colina Ruíz
F
F
Palma Carazo
F
F
Loinaz Segurola
C
C
Rodríguez González
F
F
González Pinto
I
I
García García
I
I
Rodríguez Romano
D
D
Moreno Sanz
C
C
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors