ORIGINAL ARTICLE Effects of Donor Age and Cold Ischemia on Liver Transplantation Outcomes According to the Severity of Recipient Status

Background Prolonged cold ischemic time (CIT) and increased donor age are well-known factors negatively influencing outcomes after liver transplantation (LT). Aims The aim of this study was to evaluate whether the magnitude of their negative effects is related to recipient model for end-stage liver disease (MELD) score. Methods This retrospective study was based on a cohort of 1402 LTs, divided into those performed in low-MELD (\10), moderate-MELD (10–20), and high-MELD ([20) recipients. Results While neither donor age (p = 0.775) nor CIT (p = 0.561) was a significant risk factor for worse 5-year graft survival in low-MELD recipients, both were found to yield independent effects (p = 0.003 and p = 0.012, respectively) in moderate-MELD recipients, and only CIT (p = 0.004) in high-MELD recipients. However, increased donor age only triggered the negative effect of CIT in moderate-MELD recipients, which was limited to grafts recovered from donors aged C46 years (p = 0.019). Notably, utilization of grafts from donors aged C46 years with CIT C9 h in moderate-MELD recipients (p = 0.003) and those with CIT C9 h irrespective of donor age in high-MELD recipients (p = 0.031) was associated with partic-ularly compromised outcomes. Conclusions In conclusion, the negative effects of pro-longed CIT seem to be limited to patients with moderate MELD receiving organs procured from older donors and to high-MELD recipients, irrespective of donor age. Varying effects of donor age and CIT according to recipient MELD score should be considered during the allocation process in order to avoid high-risk matches