No abstract

Over the last decade, the limited number of deceased donors has resulted in longer waiting times and increased mortality on the waitlist. 1,2 In order to tackle this growing demand and organ shortage, several efforts have been pursued to widen the donor pool. Grafts from living donation, split-liver grafts, donation after circulatory death (DCD), and extended criteria donors (ECDs) including elderly donors are increasingly being used. [3][4][5] The relationship between donor age and LT outcomes has been widely studied, with controversial results. Initial studies reported older donor age as one of the most important negative prognostic factors for patient and graft survival. 6 More recent data, however, confirmed the safety with good short-and medium-term outcomes of these grafts, when recipients were appropriately selected. 1,7 A Abstract Background: Studies have suggested transplantation using older donor livers results in similar short-term outcomes as younger donor livers; however, little data exist on long-term patient/graft outcomes of the octogenarian liver recipient. Methods: Retrospective data were collected from 2 centers, (Valencia, Spain and Rochester, MN, USA) of all recipients of octogenarian donor liver allografts from 2000 to 2011 with follow-up to 2016. The aim was to compare long-term patient/ graft survival as well as metabolic outcomes of the recipient with the octogenarian liver vs younger than 60 years donor.Results: 78 recipients of older liver allografts were compared to 78 matched controls. No difference in 10-year patient mortality was demonstrated (P = 0.074).Octogenarian livers were associated with 3-fold higher likelihood of graft failure (P = 0.002) but no increase in the risk of post-LT cardiovascular disease (P = 0.60), hypertension (P = 0.33), vascular complications (P = 0.53), or malignancy (P = 0.14).In multivariate analysis, elder livers remained a significant factor associated with rejection (P = 0.034) with a trend not reaching statistical significance for graft failure (P = 0.052).Conclusions: For appropriately selected recipients, receiving an octogenarian liver does not clearly influence patient survival but does impact early graft survival with a notable increase in early posttransplant rejection rates and re-transplantation. Over 1.5 decades, older allografts have not adversely affected metabolic outcomes. K E Y W O R D S cardiovascular, donor age, elder, liver transplantation, metabolic, survival 2 of 9 | SCHNEIDER Et al. report from the Scientific Registry of Transplant Recipient (SRTR) data once again questioned the utilization of the older donors,showing increased graft and patient mortality. 8,9 Many factors contribute to patient and graft outcomes, and most of these studies cannot separate outcomes specifically related to the donor organ received.The liver has a significant role in metabolic functions. In liver transplant recipients, the graft becomes the main organ for carbohydrate, protein, lipid, and drug metabolism, responsible for the maintenance of glucose hom...