Introduction: Use of livers from very old donors is a way to expand the donor pool, but this practice is not universally implemented due to concerns about the risk of primary non function, delayed graft function, and worse long-term graft survival. Identification of clinical variables associated with favorable outcome and decreased graft loss is pivotal using older donor grafts.

Methods: This was a retrospective single-center medical record review. From January 2001 to December 2014, 1354 liver transplants (LT) were performed. We excluded from analysis donors <18yeas (n=33); ABO-incompatible transplants (n=24); re-LT (n=56), and UNOS 1 patients (n=34). LT recipients were stratified based on donor age in two groups: 18–69 (n=692) versus ≥70 (n=515). Eventually, the 2 groups were matched with a propensity score approach and using hepatitis C virus (HCV), hepatocellular carcinoma, recipient age, recipient male gender, and model for end-stage liver disease as confounders. Two groups were finally matched: the younger donor group (18–69-year; n=515) versus the older donor group (≥70-year; n=515).

Results: The median [interquartile range] follow-up for the entire populations was 5.0 [2.1-8.6] years. No differences were observed with regard to retransplants (3.1 versus 5.2%; p= 0.12), incidence of PNF/DGF (4.7% each; p=1.0), HCV-related graft loss (31.7 versus 32.6%; p=0.79), vascular (5.4 versus 5.0%; p= 0.89) and biliary complications (14.8 versus 18.6%, p= 0.11). At multivariable analysis, the independent risk factors for graft loss were: a recipient HCV positive status (HR 2.00; 95%CI 1.56-2.58; p < 0.001), donor age (HR 1.01; 95%CI 1.00-1.02; p=0.006), donor anoxia (1.93; 95%CI 1.12-3.32; p= 0.018), and a history of donor diabetes mellitus (HR 1.48; 95%CI 1.03-2.13; p=0.036).

Conclusions: Use of elderly donors is not associated per se with an increased risk of vascular and biliary complications. In the presence of anoxia as cause of death and diabetes mellitus, an appropriate donor to recipient matching is warranted.

CITATION INFORMATION: Ghinolfi D, Lai Q, DeSimone P, Pezzati D, Cirillo G, Filipponi F. Use of Elderly Donors in Liver Transplantation: A Paired-Match Analysis at a Single Center. Am J Transplant. 2016;16 (suppl 3).

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