Results of liver transplantation from old donors.
BACKGROUND
Faced with a shortage of organs for liver transplantation, the use of grafts from older donors is justified. However, there remains little consensus on how this use impacts the graft and patient outcomes after transplantation from these older donors. The aim of the present analysis was to assess the graft and patient outcomes after liver transplantation from deceased donors >60 years of age.


METHODS
From January 2007 to January 2011, 505 subjects were identified as liver graft donors after brain death, of which 7.35% were ≥60. To determine the effect of donor age on graft and patient outcomes, we analyzed donor age, recipient age, the Model for End-State Liver Disease (MELD) score of recipients at the time of transplantation, early posttransplant complications, and mortality.


RESULTS
The posttransplant follow-up was 29 ± 25.5 months, and 3-year patient mortality from donors, grouped according to age, was 7.92% with donors <30; 15.78% with donors 30-50, 10.68% with donors 50-60, and 12.50% with donors >60. After analysis of patient and graft survival based on donor graft age, 3-year patient survival according donor age was 89.29% with donors <30, 83.85% with donors 30-50, 89.89% with donors 50-60, and 87.50% with donors >60. Analysis showed overall patient and graft survival rates from older donors were not worse than those from younger donors (P > .1). Among the cases, 3-year patient survival according to MELD score was 91.19% with a MELD of I, 85.37% with a MELD of II, and 67.67% with a MELD of III; differences in graft and patient survival when comparing low MELD I and high MELD III were significantly different (P < .01).


CONCLUSIONS
A more advanced age of a donor should not be a contraindication for liver transplantation. The present analysis shows that liver grafts from donors >60 can be used safely in older recipients who presented with relatively low MELD scores. Analyses also indicate that high MELD obtained before transplantation may be an important prognostic factor for graft and patient survival.
Department of General, Transplant and Liver Surgery Medical University of Warsaw, Warsaw, Poland. Electronic address: krzysztofdudek@o2.pl.
K
K
Dudek
Department of General, Transplant and Liver Surgery Medical University of Warsaw, Warsaw, Poland.
O
O
Kornasiewicz
Department of General, Transplant and Liver Surgery Medical University of Warsaw, Warsaw, Poland.
P
P
Remiszewski
Department of General, Transplant and Liver Surgery Medical University of Warsaw, Warsaw, Poland.
K
K
Zieniewicz
Department of General, Transplant and Liver Surgery Medical University of Warsaw, Warsaw, Poland.
T
T
Wróblewski
Department of General, Transplant and Liver Surgery Medical University of Warsaw, Warsaw, Poland.
M
M
Krawczyk
D000328:Adult; D000367:Age Factors; D000368:Aged; D000075202:Contraindications; D058625:End Stage Liver Disease / Q000145:classification / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*