title: Actual Risk of Using Very Aged Donors for Unselected Liver Transplant Candidates: A European Single-center Experience in the MELD Era.
abstract: To evaluate the whole experience of liver transplantation (LT) with donors ≥70 years in a single center not applying specific donor/recipient matching criteria.
  
  
  
  LT with very old donors has historically been associated with poorer outcomes. With the increasing average donor age and the advent of Model for End-stage Liver Diseases (MELD) score-based allocation criteria, an optimal donor/recipient matching is often unsuitable.
  
  
  
  Outcomes of all types of LTs were compared according to 4 study groups: patients transplanted between 1998 and 2003 with donors <70 (group 1, n = 396) or ≥70 years (group 2, n = 88); patients transplanted between 2004 and 2010 with donors <70 (group 3, n = 409), or ≥70 years (group 4, n = 190). From 2003, graft histology was routinely available before cross-clamping, and MELD-driven allocation was adopted.
  
  
  
  Groups 1 and 2 were similar for main donor and recipient variables, and surgical details. Group 4 had shorter donor ICU stay, lower rate of moderate-to-severe graft macrosteatosis (2.3% vs 8%), and higher recipient MELD score (22 vs 19) versus group 3. After 2003, median donor age, recipient age, and MELD score significantly increased, whereas moderate-to-severe macrosteatosis and ischemia time decreased. Five-year graft survival was 63.6% in group 1 versus 59.1% in group 2 (P = 0.252) and 70.9% in group 3 versus 67.6% in group 4 (P = 0.129). Transplants performed between 1998 and 2003, recipient HCV infection, balance of risk score >18, and pre-LT renal replacement treatments were independently associated with worse graft survival.
  
  
  
  Even without specific donor/recipient matching criteria, the outcomes of LT with donors ≥70 and <70 years are comparable with appropriate donor management.
authors.affiliation: *Department of Medical and Surgical Sciences, General and Transplant Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy †Department of Medical and Surgical Sciences, Pathology Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Valentina Rosa
authors.initials: VR
authors.lastname: Bertuzzo
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Federica
authors.initials: F
authors.lastname: Odaldi
authors.forename: Marco
authors.initials: M
authors.lastname: Di Laudo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Antonietta
authors.initials: A
authors.lastname: D'Errico
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D046148:Donor Selection / Q000379:methods*; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index