Dorry Segev had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The content of this article is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the United States Government.
Liver Failure/Cirrhosis/Portal Hypertension
Minimizing risk associated with elderly liver donors by matching to preferred recipients†
Article first published online: 4 OCT 2007
Copyright © 2007 American Association for the Study of Liver Diseases
Volume 46, Issue 6, pages 1907–1918, December 2007
How to Cite
Segev, D. L., Maley, W. R., Simpkins, C. E., Locke, J. E., Nguyen, G. C., Montgomery, R. A. and Thuluvath, P. J. (2007), Minimizing risk associated with elderly liver donors by matching to preferred recipients. Hepatology, 46: 1907–1918. doi: 10.1002/hep.21888
Potential conflict of interest: Nothing to report.
- Issue published online: 28 NOV 2007
- Article first published online: 4 OCT 2007
- Manuscript Accepted: 19 JUN 2007
- Manuscript Received: 23 FEB 2007
- Health Resources and Services Administration. Grant Number: 234-2005-370011C
Elderly liver donors (ELDs) represent a possible expansion of the donor pool, although there is great reluctance to use ELDs because of reports that increasing donor age predicts graft loss and patient death. The goal of this study was to identify a subgroup of recipients who would be least affected by increased donor age and thus best suited to receive grafts from ELDs. A national registry of deceased donor liver transplants from 2002–2005 was analyzed. ELDs aged 70–92 (n = 1043) were compared with average liver donors (ALDs) aged 18–69 (n = 15,878) and ideal liver donors (ILDs) aged 18–39 (n = 6842). Recipient factors that modified the effect of donor age on outcomes were identified via interaction term analysis. Outcomes in recipient subgroups were compared using Kaplan-Meier survival analysis. Recipients preferred for ELD transplants were determined to be first-time recipients over the age of 45 with body mass index <35, non–status 1 registration, cold ischemic time <8 hours, and either hepatocellular carcinoma or an indication for transplantation other than hepatitis C. In preferred recipients, there were no differences in outcomes when ELD livers were used (3-year graft survival: ELD 75%, ALD 75%, ILD 77%, P > 0.1; 3-year patient survival: ELD 81%, ALD 80%, ILD 81%, P > 0.1). In contrast, there were significantly worse outcomes when ELD livers were used in nonpreferred recipients (3-year graft survival: ELD 50%, ALD 71%, ILD 75%, P < 0.001; 3-year patient survival: ELD 64%, ALD 77%, ILD 80%, P < 0.001). Conclusion: The risks of ELDs can be substantially minimized by appropriate recipient selection. (HEPATOLOGY 2007.)