Effect of Elderly Donors on Long-Term Outcomes of Liver Transplantation: A Retrospective Cohort Study.

Objectives: Transplant centers are increasingly using livers from donors aged >60 years, but long-term outcomes remain unclear.

Materials and methods: We collected data from 957 adult deceased donor liver transplant recipients (conducted at our center from January 2015 through October 2023). The cohort was divided into early, middle, and late transplant era groups, each covering a 3-year interval based on transplant date. We compared 183 donors aged ≥60 years (older group [average age 64.9 ± 3.4 y]) versus 774 donors aged 18 to 59 years (young group), which we also compared after propensity score matching. We compared outcomes of older organs transplanted into older recipients versus older organs transplanted into young recipients. We conducted multivariate logistic regression analysis to identify potential factors influencing liver transplant outcomes.

Results: Over the time period, average donor age increased significantly, cold ischemia time and warm ischemia time decreased, postoperative complications decreased among older donor liver transplant recipients, and cumulative recipient and graft survival rates improved. The older donor group had fewer male donors, more donors with diabetes, and lower average donor liver weight versus the young donor group. Recipients in the older donor group had significantly lower body mass index and higher prevalence of alcoholic cirrhosis versus recipients in the young donor group. Three-month postoperative mortality rate was significantly higher in the older donor group. Subgroup analysis showed significant differences in outcomes between older donors assigned to older recipients and older donors assigned to young recipients, including higher incidence of major postoperative complications and lower 3-month mortality rate. Recipient-donor age differences, early transplant era, and postoperative peak bilirubin level may affect differences.

Conclusions: Livers from older donors can yield positive outcomes for young and old recipients. Use of organs from older donors is a viable approach to mitigate organ shortages, including for younger recipients.