Do Older Liver Grafts Have Worse Survival? The Niguarda Experience.
BACKGROUND
Elderly donor livers are thought to be marginal graft. In the present study, we aimed to identify an age threshold to consider a graft as elderly to identify the trend (if any) of the donor age in our series and to identify an efficient allocation criteria for elderly grafts.


METHODS
We reviewed in a retrospective manner our series of 1520 liver transplants, comparing graft survival under and over a certain age. On the basis of the results of this analysis, we identified a threshold of 70 years to define a graft as old. The donor age trend analysis showed an increasing rate of transplants from elderly donors.


RESULTS
To identify efficient allocation criteria for elderly graft, we stratified the series by the disease of the recipient: 556 patients underwent transplants for hepatocellular carcinoma (HCC+ group) and 964 for other diseases (HCC- group). Two hundred twenty-one patients of 556 of the HCC+ group were hepatitis c virus (HCV) negative (HCC+/HCV- group), and 312 of 964 of the HCC- group were HCV positive (HCC-/HCV+). The survival analysis showed no significant differences in comparing the outcome for elderly and young grafts in the HCC+ (P = .135) and HCC- (P = .055) groups.


CONCLUSIONS
When comparing the survival of old and young livers in the HCC+/HCV- group, the elderly livers appear to have a better outcome (P = .05); on the other hand, the same analysis in the HCC-/HCV+ group shows a worse outcome for old-aged grafts (P = .026). Therefore, the present study suggests that elderly livers should be allocated to hepatocellular carcinoma (HCC) patients and should be avoided in HCV+ recipients.
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy. Electronic address: fabio.ferla@OspedaleNiguarda.it.
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Ferla
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy.
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Mariani
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy.
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di Sandro
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy.
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Buscemi
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy.
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Lauterio
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy.
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Mangoni
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy.
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Covucci
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy.
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Giacomoni
Chirurgia Generale e dei Trapianti, Ospedale Niguarda, Milano, Italy.
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De Carlis
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult