Liver transplantation with livers from octogenarians and a nonagenarian

Abstract

Introduction. A shortage of deceased donors has compelled the use of extended-criteria donor organs in liver transplantation. The purpose of this study was to evaluate the impact of using deceased donors older than 80 years. Materials and Methods. We retrospectively evaluated 13 patients who received a liver graft from cadaveric donors older than 80 years between December 2007 and March 2014. We analyzed the donor and their recipient characteristics together with morbidity and mortality of recipients. Results. All 13 donors were older than 80 years (median age, 82.7; range, 80e93). There were 9 male and 4 female recipients with an average age of 50.7 (range, 2e65) years. All of the recipients did not have a living donor for liver transplantation. Recipients’ mean model for end-stage liver disease (MELD) score was 14.2 (range, 7e20). Graft with macroscopic steatosis was not accepted. Medium follow-up was 19.5 months. The most frequent cause for liver transplantation (LT) was hepatitis B virus (HBV) cirrhosis (8/13 patients). We had 1 case of primary nonfunction, and 4 patients died in 2 weeks after surgery. Of these patients, 2 of them received a split transplant from an 80-year-old cadaver liver. Overall the survival rate after 1 year was 61.5%. Conclusions. Deceased elderly donor usage in LT could expand the donor pool. Liver grafts from donors older than 80 years can be used in necessity or emergency situations. However, care should be taken to avoid early mortality and primary nonfunction. Procedures extending cold ischemia time such as split liver transplantation may increase the risk of primary nonfunction.