Use of Octogenarian Livers Safely Expands the Donor Pool

Abstract

The liver donor pool can be increased if liver grafts are accepted without an age limit but in good condition (hemodynamic stability, short intensive care unit stay, good liver function, soft consistency, cold ischemia time <9 hr, and no severe steatosis). Octogenarian donors should be individually assessed in the absence of these ideal conditions.

Long-term survival of recipients of liver grafts from donors older than 80 years: Is it achievable?

“…First, advanced donor age must still be considered a "particular" risk factor. 7,8 This explains the 50% graft acceptance among organs offered to our institution in the study period. Normality of liver function, absence of morphological alterations other than those correlated with physiological aging, and optimal hemodynamic state of donors were invariably present in all 12 patients.…”

“…6 Nevertheless, when other risk factors (i.e., graft steatosis or prolonged ischemia time) are ruled out, organs from very old donors might be used with good results. 7,8,10,11 Successful OLTs have been reported with donors older than 80 years 8,10 and even older than 90 years, 11 suggesting that the liver is much better preserved than other organs from aging-related damage. 15 This is thought to be responsible for early function after implantation similar to that achieved with far younger donors.…”

“…Data for donors older than 80 years are even fewer and limited to the description of early outcome. [8][9][10][11] We have been using donors older than 80 years with caution since 1998, and we report long-term results obtained to date, with a special focus on the impact of hepatitis C recurrence. …”

“…[1][2][3] In this view, use of elderly donors has been shown to negatively impact on short-and long-term survival after orthotopic liver transplantation (OLT), [4][5][6] with very few exceptions. 7,8 The ultimate frontier is the use of extremely old donors. Even if some investigators reported satisfying results in the short term with donors older than 70 years, 7-9 use of these grafts remains questionable when considering the longterm perspective.…”

Liver transplantation: Current status and novel approaches to liver replacement

“…48 Even the use of donor livers from individuals older than age 70 or 80 years of age have been used successfully. 49,50 Recurrence of Disease After Liver Transplantation…”