Differential Influence of Donor Age Depending on the Indication for Liver Transplantation – A Collaborative Transplant Study Report


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Abstract

Background.Despite steadily increasing donor age, there are no general guidelines for the use of organs from elderly donors in liver transplantation. This study focuses on identifying the recipients who are less affected from an old-donor organ graft and conversely in whom a rather unfavorable outcome is expected due to high donor age.Methods.48,261 adult liver transplantations, performed between 2000 and 2017 and reported to the Collaborative Transplant Study, were analyzed.Results.The proportion of ≥ 65-year-old donors has risen to more than 33% in recent years. The donor age has an approximately linear influence on graft survival. On average, each year’s rise in the donor age was associated with a 0.9% increase in the risk of graft loss, hazard ratio (HR) 1.009, P < 0.001. The impact of donor age was “strong” in patients with hepatitis C-related cirrhosis (HR 1.013, P < 0.001), “substantial” in patients with alcoholic cirrhosis (HR 1.007, P < 0.001), and “rather weak” in patients with hepatocellular carcinoma (HCC) (HR 1.003, P = 0.038). The increase in the risk of graft loss per year rise in donor age was 1.4% for 18- to 49-year-olds, 1.0% for middle-aged, and only 0.4% for ≥ 60-year-old recipients (all P < 0.001).Conclusions.Consequently, older recipients and especially patients with HCC seem to be less affected by an increased donor age, whereas the donor age is an important factor in all other patient groups.

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