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Quantifying the Effect of Transplanting Older Donor Livers Into Younger Recipients

The Need for Donor-recipient Age Matching

Bittermann, Therese, MD1; Goldberg, David S., MD1,2

doi: 10.1097/TP.0000000000002341
Original Clinical Science—Liver

Background Increasing recipient and donor age are independently associated with survival after liver transplantation (LT). Whether donor age differentially impacts post-LT outcomes based on recipient age is unknown.

Methods This was a retrospective cohort study using Organ Procurement and Transplantation Network data. All adult deceased-donor, single organ, primary LTs from 2002 to 2015 were included. Donor and recipient age were categorized as younger than 40 years, 40 to 59 years, and 60 years or older. Mixed-effects survival analysis evaluated the risk of graft failure and death according to the interaction of donor and recipient age categories.

Results Of 63 628 LTs, 6.6% were in recipients younger than 40 years, of which 51.4% used an age-matched donor younger than 40 years. There was a significant among-center variability unrelated to United Network for Organ Sharing region in the use of older organs in young recipients, ranging from 0% to 25% or greater (overall center median, 9.7%; interquartile range, 5.4-16.5%). There was a significant interaction between donor and recipient age (P < 0.05) such that the impact of older donor age was more pronounced in younger recipients. Transplanting livers from donors aged 40 to 59 years and 60 years or older was associated with worse graft survival in recipients younger than 40 years, but there was no difference based on donor age in recipients 60 years or older.

Conclusions There is a differential impact of using older donors in younger recipients than that in older recipients. Given their longer expected post-LT survival and the ethical imperative to maximize utilization of the scarce resource of transplantable livers, efforts should be made to allocate the highest-quality organs to those most likely to derive lasting benefit.

Using the Organ Procurement and Transplantation Network Registry (primary liver transplants performed from 2002–2015), the authors of this retrospective study assessed the differential impact of using older donors in younger as opposed to older recipients.

1 Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA.

2 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.

Received 7 February 2018. Revision received 10 April 2018.

Accepted 20 April 2018.

T.B. study design, data collection, data analysis, manuscript writing. D.G. study design, manuscript editing.

The authors declare no funding or conflicts of interest.

Correspondence: Therese Bittermann, MD, MSCE, 3400 Civic Center Boulevard Perelman Center for Advanced Medicine, South Pavilion (7th Floor) Philadelphia, PA 19104. (

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