Introduction

A continuous worsening of donor organ shortage has led to expand organ acceptance criteria. It is still theoretically possible to utilize hepatic allografts from donors greater than 80 years old, and there have been successful reports in the literature. We herein analyzed US national experience of using hepatic allografts from octogenarian donors to propose appropriate selection criteria.

Material and Method

Using US OPTN database between 2002 and 2012, we retrospectively analyzed donor and recipient risk factors, operative variables, and short-term and long-term survival after OLT's using hepatic allografts from donors > 80. Only including primary OLT's other than those from DCD's, live donors, and split liver donors, 370 recipients met study criteria, The cohort was divided by diagnosis, donor ethnicity, BMI, MELD score and transplant era.

Results

1-, 3- and 5-year graft survival rates from were 76%, 66%, and 55%. And 1-, 3- and 5-year patient survival rates were 81%, 72% and 62% respectively. Median recipient age at the time of transplantation was 60 years (26-79 years). Asian donor (p=0.007) showed poor graft survival. Higher MELD score showed poor graft (P=0.026) and patient survival (p=0.021). MELD score> 25 (p=0.02) showed poor patient survival. Patient who had more than 5 units of packed red blood cell transfused 48 hours before liver transplantation showed poor graft (p=0.01) and patient survival (p=0.01). Recipients with viral hepatitis had significantly worse outcome (p=0.015). Patients transplanted before 2007 had significantly worse survival (p=0.05) while graft survival was unaffected in patients transplanted from 2007 to 2012.

Conclusion

We propose that age alone is not a poor prognostic indicator of liver recipient outcome. With careful recipient selection, donors older than 80 years can provide important and safe expansion of liver donor pool.

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