title: Liver grafts from selected older donors do not have significantly more ischaemia reperfusion injury.
abstract: BACKGROUND
  There is a general concern that aged organs are more susceptible to ischaemia. In the light of recent proposals to change the liver allocation system by expanding regional sharing, it is feared that increased cold ischaemia time of grafts from older donors may reduce graft survival. The aim of this study was to correlate donor age and the patterns of ischaemia reperfusion injury and synthetic function early after liver transplantation.
  
  
  METHODS
  We performed a retrospective study of first transplants using a single-centre electronic database. Patterns of liver injury (based on transaminases and post-reperfusion biopsy), synthetic function (international normalized ratio [INR]), and graft and patient survival in recipients receiving liver grafts from donors aged ≥ 65 years (group 1, n= 50) were compared with equivalent patterns in a matched cohort of recipients transplanted with grafts from donors aged <65 years (group 2, n= 50).
  
  
  RESULTS
  There was no significant difference in transaminase levels from day 0 to day 6 after transplantation. When groups 1 and 2 were subdivided into two subgroups based on the duration of graft cold ischaemia time (<8 h and ≥ 8 h), there was no statistical difference in transaminase levels during the first 7 days. There were two cases (4%) of primary non-function in group 1 and one (2%) in group 2. Initial poor function did not differ significantly between the groups (26% vs. 24%; P= 0.81). In addition, there was no difference in histological changes in post-reperfusion biopsies (21% vs. 34%; P= 0.078) and rate of acute rejection episodes in the first year (30% vs. 32%; P= 0.99). There was no significant difference between groups 1 and 2 in 1-year patient and graft survivals (78% vs. 90% [P= 0.17]; 88% vs. 94% [P= 0.48], respectively).
  
  
  CONCLUSIONS
  Judiciously selected livers from aged donors are not associated with major increased susceptibility to ischaemia reperfusion injury.
authors.affiliation: Department of Surgery, Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. pnmartins@partners.org
authors.forename: Paulo N
authors.initials: PN
authors.lastname: Martins
authors.forename: Sue
authors.initials: S
authors.lastname: Chang
authors.forename: Basant
authors.initials: B
authors.lastname: Mahadevapa
authors.forename: Ann-Britt
authors.initials: AB
authors.lastname: Martins
authors.forename: Patricia
authors.initials: P
authors.lastname: Sheiner
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015427:Reperfusion Injury / Q000453:epidemiology*; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*