• William C Chapman, Neeta Vachharajani, Kelly M Collins, Jackie Garonzik-Wang, Yikyung Park, Jason R Wellen, Yiing Lin, Surendra Shenoy, Jeffrey A Lowell, and M B Majella Doyle.
• Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO. Electronic address: chapmanw@wustl.edu.
• J. Am. Coll. Surg. 2015 Jul 1; 221 (1): 59-69.

BackgroundThe shortage of donor organs has led to increasing use of extended criteria donors, including older donors. The upper limit of donor age that produces acceptable outcomes continues to be explored. In liver transplantation, with appropriate selection, graft survival and patient outcomes would be comparable regardless of age.Study DesignWe performed a retrospective analysis of 1,036 adult orthotopic liver transplantations (OLT) from a prospectively maintained database performed between January 1, 2000 and December 31, 2013. The study focus group was liver transplantations performed using grafts from older (older than 60 years) deceased donors. Deceased donor liver transplantations done during the same time period using grafts from younger donors (younger than 60 years) were analyzed for comparison. Both groups were further divided based on recipient age (less than 60 years and 60 years or older). Donor age was the primary variable. Recipient variables included were demographics, indication for transplantation, Model for End-Stage Liver Disease (MELD), graft survival, and patient survival. Operative details and postoperative complications were analyzed.ResultsPatient demographics and perioperative details were similar between groups. Patient and graft survival rates were similar in the 4 groups. Rates of rejection (p = 0.07), bile leak (p = 0.17), and hepatic artery thrombosis were comparable across all groups (p = 0.84). Hepatitis C virus recurrence was similar across all groups (p = 0.10). Thirty-one young recipients (less than 60 years) received grafts from donors aged 70 or older. Their survival and other complication rates were comparable to those in the young donor to young recipient group.ConclusionsComparable outcomes in graft and patient survivals were achieved using older donors (60 years or more), regardless of recipient age, without increased rate of complications.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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