Objectives: Individuals older than 60 years represent a large proportion of the organs available for orthotopic liver transplant. However, the use of organs from older donors remains controversial. We hypothesized that the use of older donors would not affect patient and graft survival due to significant improvements in donor-recipient management.
Materials and methods: We conducted a retrospective cohort analysis using the United Network for Organ Sharing database from February 2002 through December 2012, including non-HCV-infected adults (18 and older) who underwent primary orthotopic liver transplant. We compared patient and graft survival between 4 cohorts based on donor's age (< 60, 60-69, 70-79, and 80+ years) using the Kaplan-Meier estimator. Cox proportional hazards models were constructed to adjust for recipient and donor characteristics to estimate the risk associated with organs from older donors.
Results: We identified 35 788 liver transplant recipients. Unadjusted analyses indicated that both patient and graft survival were similar among recipients of donors older than 60 years but significantly inferior compared with those recipients who received a liver from a donor younger than 60 years. Multivariate regression revealed that all 3 categories of donor age > 60 years old were significantly associated with worse patient and graft survival. Model for End-Stage Liver Disease score was not an effective modifier of the association between donor age and survival.
Conclusions: The use of liver grafts from elderly donors has a negative impact on both patient and graft survival. Recipient's Model for End-Stage Liver Disease score did not change survival based on donor age.