Liver transplantation with donors older than 75 years

Orthotopic liver transplantation has shown successful results over the last years. For this reason there are increased numbers of patients on waiting lists. To expand the pool of liver donors, elderly donors have been used as a strategy.

We report our experience comparing donors of ≥ 75 years with younger ages for their characteristics, clinical outcomes, and survivals.

From January 2001 to December 2009, we performed 174 consecutive liver transplantation from cadaveric donors in 166 patients. During this period, we used 24 liver grafts from donors ≥ 75 years. We analyzed their outcomes retrospectively, describing donors and recipient characteristics and their clinical evolution.

The mean follow-up time among the entire study population was 42 ± 39 months. We observed an overall survival of 68.3% with similar incidences in both groups: 83% in the younger versus 78% in the older group at 1 year, and 69% versus 63%, at 5 years respectively. Both groups showed similar lengths of intensive care unit stay, cold and warm ischemia times, and intraoperative transfusion requirements. The older group had a total operative time than was longer and fewer hypotensive episodes than the younger group. There were no significant differences in the rates of rejection and retransplantation between the groups. The use of older donor livers was associated with a significantly higher rate of poor initial graft function (P = .027), an increased number of reinterventions (P = .013) in the older donor group, as well as more frequent vascular and biliar complications, without reaching significance.

Our data suggested that donor age alone did not engendered a survival disadvantage for graft or recipient. However, careful donor selection is needed to avoid additional risk factors that can increase the morbidity or mortality of the procedure.