title: Use of Elderly Allografts in Liver Transplantation.
abstract: BACKGROUND
  The use of liver allografts from elderly donors (≥70 years) has increased because of organ shortage and increased life expectancy. The aim of this study is to evaluate the current utilization of elderly donors in United States, recipient selection, and their posttransplant outcomes.
  
  
  METHODS
  A linkage between Scientific Registry of Transplant Recipients and University HealthSystem Consortium databases was performed. Between January 2007 and December 2011, 12,445 liver transplant (LT) recipients were identified and divided into 2 cohorts based on donor age: 70 years or older (n = 540) and younger than 60 years (n = 10,473).
  
  
  RESULTS
  Elderly donors accounted for 4.3% of all donors used in the 5-year period. When compared to younger donors, elderly donors were more likely to be women, shared regionally or nationally, and used at higher volume centers. Elderly donor allografts were less likely to be used in recipients with model of end-stage liver disease score higher than 27 (13.2% vs. 23.0%, P < 0.001), hospitalized (16.8% vs. 21.7%, P = 0.03), or on hemodialysis at time of transplant (2.6% vs. 8.2%, P < 0.001). Both recipient groups had similar perioperative mortality, 30-day readmission rates, and short-term patient survival. In the multivariate analysis, including recipient, donor, center and regional factors, donor age 70 years or older was associated with slightly increased risk of graft loss (hazard ratio, 1.3; 95% confidence interval, 1.08-1.56; P = 0.005).
  
  
  CONCLUSIONS
  The current trend toward the use of elderly donors in liver transplant recipients with low model of end-stage liver disease scores (<27), without hepatitis C, not hospitalized and not on dialysis, is associated with acceptable perioperative outcomes, patient survival, and slightly worse graft survival.
authors.affiliation: Division of Transplantation, Department of Surgery, Cincinnati Clinical Research Group in Surgery (CROSS), University of Cincinnati, Cincinnati, OH.
authors.forename: Flavio
authors.initials: F
authors.lastname: Paterno
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.forename: Madison C
authors.initials: MC
authors.lastname: Cuffy
authors.forename: Tayyab S
authors.initials: TS
authors.lastname: Diwan
authors.forename: Steve E
authors.initials: SE
authors.lastname: Woodle
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000367:Age Factors; D000368:Aged; D064591:Allografts; D016009:Chi-Square Distribution; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists / Q000401:mortality