Is there a too old in liver donors? An age stratified analysis of elderly liver donors above 65

Question Scarcity of available organs has led to an increase in accepting marginal grafts. While it has been established that donor age above 65 years is an independent risk factor for graft loss, further analyses within this cohort are still limited. Aim of this analysis was to investigate the influence of stratified donor age on 1-year outcome after orthotopic liver transplantations (oLT).

Methods A retrospective analysis including all oLT patients at the University Hospital Münster between 2006 and 2017 was conducted. Eligible patients were stratified for donor age: ≥ 65-69 vs. ≥ 70 years of age. Baseline donor and recipient characteristics were compared, and primary endpoint was 1-year patient survival. Secondary endpoint was overall 1-year graft survival.

Results A total of 350 oLT patients were identified, of which 47 received a graft ≥ 65-69 and 35 a graft ≥ 70 years of age. Both groups revealed a comparable recipient age while age difference between donor and recipient was 10.4 ± 8.5 (donor ≥ 65-69) and 18.1 ±12.4 years (donor ≥ 70, p = 0.002). Baseline characteristics (indication for oLT, ischemia times, MELD score and donor risk index) were similar. One-year patient survival was 76.6 % (≥65 - 69) and 68.6 % (≥ 70, p= 0.40). Overall 1-year graft survival was 72.3 % (donor ≥65 - 69) and 65.7 % (donor ≥ 70, p= 0.50).

Conclusion A slightly higher but not significant increase in graft loss and lower patient survival was found for grafts of donors older than 70 years of age compared to those between 65 and 69. While both groups revealed acceptable survival rates, these results demonstrate that donor age above 70 years is associated with an increased risk for inferior outcome for patient and graft survival within the first year after oLT.

Publication History

Article published online:
04 January 2021