Cescon M et al. (2008) Improving the outcome of liver transplantation with very old donors with updated selection and management criteria. Liver Transpl 14: 672–679

Use of so-called extended-criteria liver donors, such as elderly individuals, is one approach to expanding the donor pool; however, a concern is that graft and recipient survival might be compromised as a result. Cescon and colleagues retrospectively analyzed the effect of donor age on transplantation outcome in 553 consecutive procedures, performed at a single Italian center.

All procedures were primary, whole-liver transplantations from deceased donors, and were analyzed according to five donor-age categories: <50 years (group 1, n = 173); 50–59 years (group 2, n = 96); 60–69 years (group 3, n = 132); 70–79 years (group 4, n = 111); and ≥80 years (group 5, n = 41).

Five-year graft and patient survival was significantly higher in groups 1 and 5 (75% and 81%, respectively) than in groups 3 and group 4 (60% and 62%, respectively). On multivariate analysis, donor age 60–79 years and recipient HCV positivity, Model for End-Stage Liver Disease score ≥25 and United Network for Organ Sharing score 1 were predictors of poor outcome. Five-year graft survival in HCV-positive recipients was 72% for group 1, 85% for group 2, 52% for group 3, 65% for group 4 and 71% for group 5 donors.

The authors conclude that livers harvested from octogenarian donors can be used in transplantation with satisfactory outcomes, provided the organs are exposed to minimal ischemia times and routine biopsy is performed to ensure histopathological viability.