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Actual Risk of Using Very Aged Donors for Unselected Liver Transplant Candidates: A European Single-center Experience in the MELD Era

Bertuzzo, Valentina Rosa MD; Cescon, Matteo MD, PhD; Odaldi, Federica MD; Di Laudo, Marco MD; Cucchetti, Alessandro MD; Ravaioli, Matteo MD, PhD; Del Gaudio, Massimo MD, PhD; Ercolani, Giorgio MD, PhD; D’Errico, Antonietta MD, PhD; Pinna, Antonio Daniele MD, PhD

doi: 10.1097/SLA.0000000000001681
ORIGINAL ARTICLES

Objective: To evaluate the whole experience of liver transplantation (LT) with donors ≥70 years in a single center not applying specific donor/recipient matching criteria.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: Even without specific donor/recipient matching criteria, the outcomes of LT with donors ≥70 and <70 years are comparable with appropriate donor management.

*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.

Reprints: Matteo Cescon, MD, PhD, Unità Operativa di Chirurgia Generale e Trapianti, Padiglione 5, Policlinico Sant’Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. E-mail: mailto:matteo.cescon@unibo.it.

Authorship: VRB and MC conceived the study, performed the analysis, and wrote the paper; FO and MDL acquired the data; AC, MR, and MDG participated in drafting the article; GE and ADP critically revised the paper; ADE revised the histological analysis and critically revised the paper. All the authors approved the final version of the paper.

Funding: This work was supported in part by the fund “Ricerca Fondamentale Orientata (ex 60%)” of the University of Bologna, Italy.

Disclosure of conflicts: None to declare.

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