Use of elderly donors for liver transplantation: has the limit been reached?

Background & Aim: Several solutions have been proposed for the minimization of both organ shortage and prolonged waiting time for liver transplantation (LT): expansion of the donor pool using elderly donors represents a possible solution. However, it is still not fully explained if the use of "extreme" donors could cause inacceptable post-transplant adjunctive risks. The aim of the study is to evaluate the impact of donor age on post-LT patient and graft survival. Methods: A cohort of 188 LTs were stratified in four groups according to donor age (Group 1: age < 30 years: n=34; Group 2: age 30-49 years: n=51; Group 3: age 50-69 years: n=75; Group 4: age 70-89 years: n=28). Donor, recipient and transplantation characteristics were compared in the four groups. Results: No differences were observed among the groups with regard to initial (< 1 week) graft function; vascular thrombosis was predominantly experienced in the oldest subgroup (p-value 0.03). The oldest subgroup presented a 5-year patient survival of 47.0%, with statistically worse results with respect to the 1st and 2nd group (p-value 0.005 and 0.03, respectively). Analyzing the graft survivals, Group 4 had a 5-year survival rate of 40.7%, presenting statistically worse results with respect to the 1st and 2nd group (p-value 0.003 and 0.006, respectively). Conclusions: Use of > 70 year-aged donors should be considered with caution and only in selected cases.