Liver Transplantation from Elderly Donors (≥85 Years Old)

• Published in: Cancers 2024-05, Vol.16 (10), p.1803
• Main Authors: Romano, Pierluigi, Cano, Luis, Pietrasz, Daniel, Beghdadi, Nassiba, Allard, Marc-Antoine, Salloum, Chady, Blandin, Frédérique, Ciacio, Oriana, Pittau, Gabriella, Adam, René, Azoulay, Daniel, Sa Cunha, Antonio, Vibert, Eric, De Carlis, Luciano, Vitale, Alessandro, Cillo, Umberto, Cherqui, Daniel, Golse, Nicolas
• Format: Article
• Language: English
• Subjects: Age; Aged; Allografts; Blood & organ donations; Donors; Forecasts and trends; Health aspects; Hepatocellular carcinoma; Ischemia; Life Sciences; Liver; Liver cancer; Liver diseases; Liver transplantation; Liver transplants; Logistics; Medical imaging; Medical prognosis; Nomograms; Patients; Regression analysis; Survival; Survival analysis; Transplantation; Variables
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16101803

Despite the ongoing trend of increasing donor ages in liver transplantation (LT) setting, a notable gap persists in the availability of comprehensive guidelines for the utilization of organs from elderly donors. This study aimed to evaluate the viability of livers grafts from donors aged ≥85 years and report the post-LT outcomes compared with those from "ideal" donors under 40 years old. Conducted retrospectively at a single center from 2005 to 2023, this study compared outcomes of LTs from donors aged ≥85 y/o and ≤40 y/o, with the propensity score matching to the recipient's gender, age, BMI, MELD score, redo-LT, LT indication, and cause of donor death. A total of 76 patients received grafts from donors ≥85 y/o and were compared to 349 liver grafts from donors ≤40 y/o. Prior to PSM, the 5-year overall survival was 63% for the elderly group and 77% for the young group ( = 0.002). After PSM, the 5-year overall survival was 63% and 73% ( = 0.1). A nomogram, developed at the time of graft acceptance and including HCC features, predicted 10-year survival after LT using a graft from a donor aged ≥85. In the context of organ scarcity, elderly donors emerge as a partial solution. Nonetheless, without proper selection, LT using very elderly donors yields inferior long-term outcomes compared to transplantation from very young donors ≤40 y/o. The resulting nomogram based on pre-transplant criteria allows for the optimization of elderly donor/recipient matching to achieve satisfactory long-term results, in addition to traditional matching methods.