title: Donor characteristics that are associated with survival in liver transplant recipients older than 70 years with grafts.
abstract: BACKGROUND
  The use of grafts from donors older than 70 years of age is increasing due to the decrease in the number of donors and the increase in waiting list patients.
  
  
  METHODS
  We undertook a univariate and multivariate analysis of 980 adult recipients of whole liver grafts, 129 of them from donors aged 70 years or older.
  
  
  RESULTS
  No differences were found in patient survival compared with recipients of younger grafts. There were no higher rates of rejection, vascular or biliary complications, postoperative bleeding, or infections, but older grafts were associated with graft dysfunction (P = .01) and a higher frequency of postoperative refractory ascites (P = .007), but without a greater need for retransplantation. As graft-associated factors, the joint presence in the donor of diabetes (P = .00; confidence interval [CI] = 0.04-0.117), hypertension (P = .00; CI = 0.22-0.39), and weight of more than 90 kg (P = .031; CI = 0.05-0.104) were suggestive of poor prognostic factors in recipient survival. Survival in hepatitis C virus (HCV) recipients or recipients aged older than 60 years was worse with donors aged older than 70 years, although not significantly so. With grafts from donors aged older than 80 years (n = 15), although patient survival rate was good (70% at 10 years), there was a higher rate of retransplantation (20%) and the early mortality rate was 13.3%.
  
  
  CONCLUSIONS
  Use of grafts from donors aged older than 70 years is safe, with similar survival to patients with younger grafts. The appearance of initial dysfunction with prolonged ascites may be due to a delay in reaching a correct functionality, but was not associated with increased mortality, complications, or need for retransplantation. It should also be avoided in recipients older than 60 years or with HCV. Grafts older than 80 years were associated with a good long-term patient survival but at the expense of a higher rate of retransplantation. However, it helps to reduce the time on the waiting list and, thus, mortality. We noted decreased survival associated with donor hypertension, diabetes, and obesity, so these donors should be selected more rigorously.
authors: Liver Transplant Unit, Virgen del Rocío Hospital, Seville, Spain. Electronic address: jmalamom@hotmail.com.
authors: J-M
authors: JM
authors: Alamo
authors: C
authors: C
authors: Olivares
authors: G
authors: G
authors: Jiménez
authors: C
authors: C
authors: Bernal
authors: L M
authors: LM
authors: Marín
authors: J
authors: J
authors: Tinoco
authors: G
authors: G
authors: Suárez
authors: J
authors: J
authors: Serrano
authors: J
authors: J
authors: Padillo
authors: M-Á
authors: MÁ
authors: Gómez
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D051799:Delayed Graft Function / Q000209:etiology / Q000601:surgery; D046148:Donor Selection; D006084:Graft Rejection / Q000209:etiology / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D012307:Risk Factors; D013030:Spain; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome