Liver Transplantation from Elderly Donors (≥85 Years Old)

Abstract

Background: 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.

Methods: 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.

Results: 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 (p = 0.002). After PSM, the 5-year overall survival was 63% and 73% (p = 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.

Conclusions: 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.

Keywords: donor age; elderly donors; liver transplantation; outcomes; propensity score matching.

Figure 1

Kaplan–Meier curves depicting the influence of the donor age on outcomes in liver transplantation recipients (after PSM).

Figure 2

Nomogram illustrating donor–recipient matching optimization based on recipient data. The nomogram illustrates the predictive power for 10-year survival in cases where the donor is ≥85 years old. The variables used to calculate survival include the following: alpha-fetoprotein (AFP) level, waiting time on the transplant list, recipient size and weight, and tumor size. The dashed line on the nomogram correspond to the scores assigned to each variable based on their value. The sum of the total scores corresponds to the estimate of the probability of 10-year survival for the patient after liver transplantation.