title: Using old liver grafts for liver transplantation: where are the limits?
abstract: The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. Fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Jiménez-Romero
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Caso Maestro
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Cambra Molero
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Iago
authors.initials: I
authors.lastname: Justo Alonso
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Alegre Torrado
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Manrique Municio
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Calvo Pulido
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Loinaz Segurola
authors.affiliation: Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, 28041 Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Moreno González
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D046148:Donor Selection; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Aging; Aging liver; Donor management; Liver disease; Liver graft; Liver transplantation; Octogenarian donors; Old liver donors; Septuagenarian donors