Liver transplantation from donors aged 80 years and over: pushing the limit.
Older donors are a growing part of the total donor pool but no definite consensus exists on the limit of age for their acceptance. From November 1998 to January 2003, in a retrospective case-control multicenter study, we compared the outcome of 30 orthotopic liver transplantations (OLTs) with octogenarian donors and of 60 chronologically correlated OLTs performed with donors <40 years. The percentage of refusal was greater among older than younger donors (48.2 vs. 14.3%; p < 0.001). Cold ischemia was significantly shorter in the older than younger groups. Recipients with hepatocarcinoma and older age received octogenarian grafts more frequently. No differences were seen in post-operative complications and 6-month graft and patient survival. However, long-term survival was lower in patients transplanted with octogenarian donors (p = 0.04). Interestingly, the mortality related to hepatitis C recurrence was greater in patients with octogenarian donors. Accordingly, the long-term survival of HCV-positive patients who received older grafts was lower than those receiving younger grafts (p = 0.05). Octogenarian livers can be used safely but a careful donor evaluation and a short cold ischemia are required to prevent additional risk factors. However, hepatitis C recurrence is associated with a greater mortality in patients who received octogenarian grafts raising concerns whether to allocate these livers to HCV-positive recipients.
Nardo
Bruno
B
University of Bologna, Departement of Surgery and Transplantation, Bologna, Italy. nardo@orsola-malpighi.med.unibo.it
Masetti
Michele
M
Urbani
Lucio
L
Caraceni
Paolo
P
Montalti
Roberto
R
Filipponi
Franco
F
Mosca
Franco
F
Martinelli
Gerardo
G
Bernardi
Mauro
M
Daniele Pinna
Antonio
A
Cavallari
Antonino
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006526:Hepatitis C / Q000378:metabolism / Q000517:prevention & control / Q000821:virology; D006801:Humans; D007511:Ischemia; D008113:Liver Neoplasms / Q000378:metabolism; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011516:Prothrombin / Q000096:biosynthesis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
D011516:Prothrombin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin