The impact of donor age on liver transplantation: influence of donor age on early liver function and on subsequent patient and graft survival.
BACKGROUND
The urgent need to increase the organ donor pool has led to the expansion of criteria for donor selection. The aim of this study was to analyze the influence of donor age on early graft function, subsequent graft loss, and mortality after liver transplantation (LT).


METHODS
Data on LT were evaluated retrospectively in a population-based cohort of 400 LTs in 348 patients. Of these, 21 (5%) were from donors >70 years old. Pretransplantation donor and recipient characteristics and the evolution of recipients were analyzed. The influence of donor age as a risk factor was assessed using univariate and multivariate analyses.


RESULTS
Actuarial graft survival was 89% at 1 month after LT, 81% after 6 months, and 59% after 60 months. Multivariate analysis demonstrated that only donor age (>70 years old) was associated with a higher risk of long-term graft loss (relative risk [RR]=1.4, 95% confidence interval [CI]=1-1.9; P=0.03) and mortality (RR=1.7, 95% CI=1.2-2.3; P=0.01). Graft survival of septuagenarian livers was 80% at 1 month after LT, 56% after 6 months, and 25% after 54 months. Actuarial survival analysis (Kaplan-Meier curves) also demonstrated worse evolution in recipients of livers from old donors (log-rank test, P<0.001).


CONCLUSIONS
Advanced donor age is associated with lower graft and recipient survival.
Busquets
J
J
Department of Surgery, Hospital Princeps d'Espanya, C/Feixa llarga s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain.
Xiol
X
X
Figueras
J
J
Jaurrieta
E
E
Torras
J
J
Ramos
E
E
Rafecas
A
A
Fabregat
J
J
Lama
C
C
Ibañez
L
L
Llado
L
L
Ramon
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D002423:Cause of Death; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors