Clinical

Liver transplants safe with elderly donors

Last Updated: 2008-12-29 10:07:11 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Advanced donor age, per se, does not adversely affect recipient or graft survival after liver transplantation, according to a report in the December Journal of the American College of Surgeons.

Previous reports have indicated that donor age beyond 60 years old independently contributes to decreased graft and patient survival, as well as recipient quality of life, the authors explain. They hypothesized, however, "that proper selection of donors older than age 60 and even over age 70" results in outcomes comparable to those with donors younger than 60.

Dr. William C. Chapman and colleagues from Washington University School of Medicine, St. Louis, Missouri analyzed their experience with 741 adult-to-adult whole organ transplants; 91 from donors 60 years or older, 650 from younger donors.

There was no significant difference in the rates of retransplantation or the indications for retransplantation between patients who received organs from donors younger than 60 years or those who had donors 60 years or older, the authors report.

Overall survivals did not differ between the two groups of patients, the researchers note. Five-year survival, for example, was 67.6% in the group given organs from older donors compared with 75.5% with younger donors (p = 0.39).

Similarly, graft survivals were not significantly different between the recipients from younger and older donors, even when they were divided into three donor age groups -- under 60 years, 60-69 years, and 70 years and older.

Moreover, the investigators say, there was no difference in overall or graft survival between groups with different MELD (Model for End-Stage Liver Disease) scores when recipients of organs from older and younger donors were compared.

Cold ischemic times were significantly shorter for organs from older donors than were those for organs from younger donors, the report indicates.

"Our analysis was not able to identify any significant disadvantage in graft or patient survival based on donor age," the authors conclude.

"Attention to other donor risk factors, cold ischemic times, and potential recipient factors are all important to ensure optimal outcomes after transplantation using older donor grafts," they add. "These older donors represent an important and safe expansion of the donor pool."

J Am Coll Surg 2008;207:847-852.