title: Use of elderly donors for liver transplantation: has the limit been reached?
abstract: OBJECTIVE
  Several solutions have been proposed for the minimization of both organ shortage and prolonged waiting time for liver transplantation (LT): expansion of the donor pool using elderly donors represents a possible solution. However, it is still not fully explained if the use of "extreme" donors could cause inacceptable post-transplant adjunctive risks. The aim of the study is to evaluate the impact of donor age on post-LT patient and graft survival.
  
  
  METHODS
  A cohort of 188 LTs were stratified in four groups according to donor age (Group 1: age < 30 years: n=34; Group 2: age 30-49 years: n=51; Group 3: age 50-69 years: n=75; Group 4: age 70-89 years: n=28). Donor, recipient and transplantation characteristics were compared in the four groups.
  
  
  RESULTS
  No differences were observed among the groups with regard to initial (< 1 week) graft function; vascular thrombosis was predominantly experienced in the oldest subgroup (p-value 0.03). The oldest subgroup presented a 5-year patient survival of 47.0%, with statistically worse results with respect to the 1st and 2nd group (p-value 0.005 and 0.03, respectively). Analyzing the graft survivals, Group 4 had a 5-year survival rate of 40.7%, presenting statistically worse results with respect to the 1st and 2nd group (p-value 0.003 and 0.006, respectively).
  
  
  CONCLUSIONS
  Use of > 70 year-aged donors should be considered with caution and only in selected cases.
authors.affiliation: Department of General Surgery, Sapienza University, Umberto I Hospital, Rome, Italy. lai.quirino@libero.it
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Fabio
authors.initials: F
authors.lastname: Melandro
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Levi Sandri
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mennini
authors.forename: Stefano Ginanni
authors.initials: SG
authors.lastname: Corradini
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.forename: Pasquale Bartolomeo
authors.initials: PB
authors.lastname: Berloco
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014850:Waiting Lists