Use of liver grafts ≥ 80 years. The lessons learned after over 150 transplants

Background: We have previously demonstrated that elderly (≥ 80 years) grafts may provide favorable long-term results after liver transplantation (LT). However, they are associated with an increased risk for ischemic-type biliary lesions (ITBL) and hepatitis C virus (HCV) recurrence after compared to standard donor grafts. Methods: This was a retrospective, case-control analysis on use of elderly liver grafts (≥ 80 years) for LT at a single institution. From January 2003 thru June 2014, 154 LT were performed with deceased donors ≥ 80 years vs. 131 with donors 18–39 years. Patients were matched on a 1:1 basis as per indication to LT, model for end-stage liver disease (MELD) score at transplantation, cold (CIT) and warm ischemia time (WIT). Finally,a total of 106 recipients of grafts ≥ 80 years (Group A) were compared against 106r recipients of standard donor grafts (18–39 years, Group B). The primary end-point was graft and patient survival rate between the groups. The secondary end-point was assessment of ITBL and HCV-related graft loss. Graft survival was censored at time of re-listing or re-transplantation. Patient survival was censored at time of death, lost to follow-up or as of December 2014. Survival rates were according to Kaplan-Meier and the level of statistical significance was set at 5%. Results: In Group A vs. Group B, HCV-related graft loss was 20/106 (18.9%) vs. 6/106 (5.7%) (p = 0.0059; OR = 3.87); incidence of ITBL was 16/106 (15.1%) vs. 6/106 (5.7%) (p = 0.040; OR = 2.96),and incidence of ITBL-related graft loss was 5/106 (4.7%) vs. 0 (0%) (p = 0.059). ITBL-related patient death was 3/106 (2.8%) vs.0 (0%) (p = 0.246) in Group A and B, respectively. Graft survival was 90.9%, 84.9%, and 75.8% at 1, 3 and 5 years in Group A vs. 92.5%, 88.4%, and 87.2% in Group B (p = 0.03,log rank). Conclusions: Although associated with a 5-year graft survival rate of 75.8%, liver donor grafts ≥ 80 years have a 4-fold increased odds for HCV-related graft failure and a 3-fold increased odds for ITBL, respectively. Novel antiviral treatments and continued management of ITBL will likely contribute to further improvements of these results, reducing the gap between elderly and standard donor grafts