A recent retrospective study (JD de Boer et al. Liver Transplantation 2019; 25: 260-74) helps address the question of whether/when a geriatric liver is too old for donation.
The authors culled data from 2000-2015 from 17,811 first liver transplantations performed in the Eurotranplant region.
- 2394 (13%) transplants were performed with livers ≥70 years old
- Graft survival was reduced from donors with a history of diabetes (HR 1.3) and in recipients with hepatitis C virus (HCV) antibody (HR 1.5)
- “Although donor age is associated with a linearly increasing risk of graft loss between 25 and 80 years old, no differences in graft survival could be observed when “preferred” recipients were transplanted” with older grafts (HR 1.1).
- Preferred recipients: 1. HCV-Ab neg, 2. Recipient >45 years old, 3. BMI <35 kg/m2, 4. cold ischemia time < 8 hours. 26% of recipients were considered “preferred” recipients
- Utilization of livers from donors ≥70 years old increased from 42% (2000-2003) to 76% (2013-2015).
- The median donor age increased from 42 to 55 years old from 2000 to 2015.
- The oldest transplanted liver was 98 years old!
The overall Kaplan-Meier survival curves are given in Figure 2 and there is a clear trend of better graft and patient survival with donors <70 years of age. However, Figure 4 shows that graft survival with “preferred” recipients was essentially identical when comparing grafts from donors <70 compared to >70. However, when comparing graft survival from donors <40 compared to donors >70, there appeared to be a small advantage for the younger organs, though this did not meet statistical significance. (HR 1.2 CI 0.96-1.37).
My take: Given the shortage of available livers, the use of older donor organs is a necessity and can be accomplished without significant loss of grafts in selected patients.
Related blog posts:
- Weak Link in Liver Transplantation Survival
- Pediatric Liver Transplantation: Past Time to Split
- Picking winners and losers with liver transplantation allocation
- Should Younger Transplant Patients Receive Better Organs? | gutsandgrowth
- Geographic Inequity for Liver Transplantation
- Liver Transplant Recipients Are Getting Older | gutsandgrowth
- Big gift, how much risk
- Weak Link in Liver Transplantation Survival | gutsandgrowth