Skip to main content
NCBI home page
HPB : The Official Journal of the International Hepato Pancreato Biliary Association logoLink to HPB : The Official Journal of the International Hepato Pancreato Biliary Association
. 2014 Jan 28;16(9):852–858. doi: 10.1111/hpb.12221

Excellent long-term patient and graft survival are possible with appropriate use of livers from deceased septuagenarian and octogenarian donors

Marcio F Chedid 1, Charles B Rosen 1,✉, Scott L Nyberg 1, Julie K Heimbach 1
PMCID: PMC4159459  PMID: 24467292

Abstract

Background

Although increasing donor age adversely affects survival after liver transplantation, livers have been used from selected deceased donors older than 70 years. Although there are reports of excellent short-term results, long-term results are unknown. Our experience was reviewed with septuagenarian and octogenarian deceased donors to determine long-term outcomes.

Methods

All primary deceased donor liver transplants performed at our institution between July 1998 and December 2010 were reviewed. Recipients of livers procured after circulatory arrest, split and reduced-size livers and multiple organ transplants were excluded from the study. Patient and graft survival were calculated using the Kaplan–Meier method, and survival comparisons were made with the log-rank test.

Results

In total, 780 patients met inclusion criteria, and 109 patients received livers from donors older than 70 years (range = 70–86). There were no differences in long-term patient (P = 0.67) or graft (P = 0.42) survival between hepatitis C negative recipients of livers from older compared with younger donors. In contrast, 7-year survival for HCV-positive recipients of older donor livers was less than half that of HCV-negative recipients.

Discussion

Transplantation of livers from septua- and octogenarian donors can achieve excellent long-term patient and graft survival for selected HCV-negative patients.

Introduction

Liver transplantation is the standard of care for patients with life-threatening acute and chronic liver disease, selected malignancies and metabolic diseases. Unfortunately, there are simply not enough deceased donor livers available for those in need of liver transplantation.1 Numerous strategies to alleviate this donor shortage have included the use of livers procured after circulatory arrest, livers from donors with a higher risk of disease transmission, livers with a higher risk of graft dysfunction or failure; split liver grafts; and living donor liver transplantation.

Increasing donor age is known to adversely affect patient and graft survival.2–7 Nevertheless, we wondered whether we could achieve satisfactory patient and graft survival with the use of livers from older donors. In 1998, we decided to expand our use of older donor livers for selected patients: older patients, patients with malignancies, patients perceived to be at a higher risk of death than predicted by their model for end-stage liver disease (MELD) scores and critically ill patients that might not survive until a younger donor liver would become available for them. We began using livers from septua- and octogenarian donors and observed satisfactory short-term results.8 Encouraged by our early success and reports by others,9,10 we increased our use of older donor livers. The specific aim of this study was to determine whether the use of livers from septua- and octogenarian decreased donors affected long-term patient and graft survival.

Methods

We performed an Institutional Review Board approved retrospective analysis of all adult (age ≥ 18 years) patients that underwent primary deceased donor liver transplantation at Mayo Clinic Rochester between 1 July 1998 and 31 December 2010. Recipients of liver allografts from living and domino amyloid donors, donor organs procured after circulatory arrest, split and reduced-size livers and recipients of simultaneous transplants (heart–liver and kidney–liver) were not included in this study.

Deceased donor liver acceptance decisions were made after review of donor clinical, biochemical, anatomical and histological information. Liver biopsies were obtained on all donors at the time of procurement and interpreted immediately for donors with suspicion of significant steatosis or liver disease. We used older donor livers with mild (5%–33%) macrosteatosis, but we discarded older donor livers with moderate (34%–66%) macrosteatosis and severe (>66%) macrosteatosis. Pre-procurement percutaneous liver biopsies were obtained for some older donors in order to avoid costs of non-productive procurement operations and travel.

Organ procurement for older donors was done in an identical fashion to the procurement of livers from younger donors, with an exception for donors with atherosclerosis precluding aortic catheterization. All donor organs were procured with vascular dissection and division of the common bile duct prior to perfusion with University of Wisconsin solution (Via-Span, Barr Laboratories Inc., Pomona, NY, USA or generic equivalent) or Histidine-tryptophan-ketoglutarate, or Custodiol HTK (Essential Pharmaceutical, Newton, PA, USA) through the distal aorta and portal vein with 3 and 2 litres, respectively, or until the hepatic vein effluent was clear. Several older donors with severe aortic atherosclerosis or aortic dissection were flushed directly through the celiac or common hepatic artery (along with portal perfusion).

Recipient selection and deceased donor liver allocation were done in complete accord with United Network for Organ Sharing policy. Realizing that older donor livers might pose higher risks for graft loss and death, we accepted older donor liver offers for patients thought to be at increased risk for death or disease progression compared with other patients with similar MELD scores (after February 2002) or waiting time (prior to February 2002). Decisions to accept any given organ were made in the best interest for each patient in order on the donor match run. We tried to lessen the likelihood of prolonged cold ischaemia time for older donor livers by avoiding patients with technically challenging operations. We also occasionally began the transplant operation prior to organ arrival at the transplant centre to minimize the cold ischaemia time, especially for distant procurements. We made sure that ABO compatible vessels were available for patients receiving older donor livers that were likely to need arterial grafts – especially patients with cholangiocarcinoma for whom we routinely use an infrarenal aortic arterial graft. Immunosuppression was per our standard protocol (tacrolimus, mycophenolate mofetil, and steroids with discontinuation of steroids and mycophenolate mofetil by 3 months), regardless of donor age.

Patient and graft survival were calculated using the Kaplan–Meier method, and survival comparisons were done with the log-rank test. Results were stratified by donor age (older versus younger than 70 years) and hepatitis C status. Comparisons of categorical variables were performed using the Chi-square test, and numerical variables were compared using Wilcoxon's test. Importantly, we analysed calculated MELD scores at the time of transplantation, rather than appealed scores. For patients transplanted before February 2002 (beginning of MELD), we calculated MELD scores based on laboratory values at the time of transplantation. P-values <0.05 were considered statistically significant.

Results

Seven hundred and eighty primary adult liver transplants were performed at Mayo Clinic Rochester between 1 July 1998 and 31 December 2010 and met criteria for inclusion in this study. One hundred nine patients received allografts from deceased donors ≥ 70 years (median 76, range 70–86), including 28 patients that received allografts from deceased donors ≥ 80 years. These patients account for 109 of the 2563 (4.3%) patients that received livers from donors older than 70 and 28 of the 365 (7.7%) patients that received livers from donors older than 80 in the United States during the period of this study (Scientific Registry of Transplant Recipients, individual data request March 2013).

The remaining 671 patients received allografts from donors <70 years (median 43, range 6–69). Donor and transplant operative data (Table 1) show comparable donor gender, anastomotic times and cold ischaemia times between recipients of older versus younger donors. The median serum creatinine for old donors was 1.2 versus 1.0 for young donors (P = 0.007). The median serum glutamic oxaloacetic transaminase (GOT) was 34 for old donors and 42 for younger donors (P = 0.04). The median serum glutamate pyruvate transaminase (GPT) was 24 for the older donor group and 33 for the younger donors (P < 0.0001). The median total bilirubin was 0.7 for both groups (P = 0.73). There were no differences in the degree of macrosteatosis between the older and younger donor liver groups. Mild macrosteatosis was present in 29% of the older donor livers and 24% of the younger donor livers. Moderate macrosteatosis was present in only 1% of the older donor livers (one graft) and 1.6% of the younger donor group. Severe macrosteatosis was present in none of the older donor livers and only 0.3% (two grafts) of the younger donor group. Overall, macrosteatosis had an adverse effect on graft survival (P = 0.02). This adverse effect was no different between the older donor and younger donor groups (P = 0.92). For livers without any steatosis, graft survival for livers from older donors was below that for the younger donor group, but the difference was borderline (P = 0.053). Older donor recipients were significantly older than younger donor recipients (median age 57 versus 53 years, P = 0.0003), which was the intent of our policy for older donor utilization. There were no statistical differences in recipient gender, race, MELD scores, and malignancy as a primary diagnosis between the older and younger donor recipients.

Table 1.

Comparison of donor, transplant and recipient variables

Donors > 70 years Donors < 70 years P-value
Number of patients 109 671
Median donor age 76 (70–86) 43 (6–69) <0.0001
Donor gender, male (%) 56 (51%) 395 (59%) 0.14
Preservation solution, UW (%) 79 (75%) 495 (75%) 0.92
Median anastomosis time (min) 43 (23–87) 45 (27–72) 0.44
Median cold ischaemia time (min) 452 (188–532) 449 (144–880) 0.15
Median recipient age, years (range) 57 (21–71) 53 (18–73) 0.0003
Recipient gender, male (%) 62 (57%) 431 (64%) 0.14
Race, Caucasian (%) 100 (92%) 580 (88%) 0.25
MELD score, median (range) 19 (6–42) 18 (6–49) 0.54
Malignancy (%) 40 (37%) 251 (37%) 0.89
Hepatitis C (%) 10 (9%) 153 (23%) 0.0012
Open in a new tab

University of Wisconsin (UW) preservation solution (Via-Span, Barr Laboratories Inc., Pomona, NY, USA or generic equivalent). HTK (Essential Pharmaceutical, Newton, PA, USA) was the other preservation solution.

Fewer older donor recipients had hepatitis C compared with the younger donor recipients (9% versus 23%, P = 0.0012) which was the intent of our policy for older donor liver utilization. The most common indications for liver transplantation among patients receiving livers from septuagenarian and octogenarian donors were hepatocellular carcinoma (n = 20), hilar cholangiocarcinoma (n = 14), alcoholic cirrhosis (n = 14) and primary biliary cirrhosis (n = 11).

The median post-transplant hospital stay was 9.7 days for recipients of old livers and 9.4 days for the younger donor group (P = 0.22). There were no differences in the rates of primary non-function and early graft dysfunction leading to retransplantation and/or patient death between recipients of younger compared with older livers (2.75 for old donor liver recipients and 2.24 for younger donor group, P = 0.73). There were no differences in arterial complications (0.9% for recipients of old livers versus 3% for the younger donor group, P = 0.34), portal vein complications (0% for recipient of old livers versus 1.2% for the younger donor group, P = 0.61) or inferior vena cava complications (1.64 for old liver recipients versus 0.92 for the younger donor group, P > 0.99). There were also no statistically significant differences in vascular complications between the two groups (1.8% for recipients of old livers versus 5.5% for the younger donor group, P = 0.15). Interestingly, recipients of livers from old donors had no biliary complications compared with a 6.4% incidence of biliary complications for the younger donor group (P = 0.002).

There were no statistically significant differences in patient (P = 0.89) or graft (P = 0.15) survival between recipients of septua- and octogenarian donor livers (Fig. 1a,b). However, hepatitis C positive recipients had significantly worse patient (P = 0.03) and graft (P = 0.006) survival for those that received livers from donors ≥ 70 years compared with those that received livers from donors < 70 years (Fig. 2a,b). They also had significantly worse patient (P = 0.009) and graft (P = 0.015) survival when compared with hepatitis C negative recipients that received livers from donors ≥ 70 (Fig. 2a,b). Indeed, patient and graft survival for hepatitis C positive patients at 7 years after transplantation were less than half of the results observed in the other patient groups (Fig. 2c). Seven of the 10 hepatitis C positive patients that received livers from septuagenarian donors developed graft failure resulting in death or retransplantation, and five of these graft failures were as a result of recurrent hepatitis C.

Figure 1.

Figure 1

Open in a new tab

(a) Patient survival for liver transplant recipients of liver allografts from donors > 70 years old versus recipients of livers from donors < 70 years old (P = 0.89). (b) Graft survival for liver transplant recipients of liver allografts from donors > 70 years old versus recipients of livers from donors < 70 years old (P = 0.15)

Figure 2.

Figure 2

Open in a new tab

(a) Patient survival according to donor age and hepatitis C status of the recipient; P = 0.01, for four group comparison; P = 0.24, for three group comparison (excluding hepatitis C positive recipients of liver allografts from deceased donors ≥70 years). (b) Graft survival according to donor age and hepatitis C status of the recipient; P = 0.006 for four group comparison; P = 0.47 for three groups comparison (excluding hepatitis C positive recipients who received livers from deceased donors ≥70 years). (c) Patient and graft survival according to HCV status and donor age

We did not observe significant differences in patient or graft survival attributable to hepatitis C for recipients of livers from donors < 70 years (Fig. 2a,b,c). We also did not observe significant differences in patient or graft survival attributable to donor age in non-hepatitis C patients (Fig. 2a,b,c) or in patients with cholestatic liver disease (primary sclerosing cholangitis and primary biliary cirrhosis).

Patients with HCV genotypes 2 and 3 had better patient survival (90% and 87.5% by 7 years) than patients with HCV genotypes 1 and 4 (72.4% and 60%). Patients with HCV genotypes 2, 3 and 4 also had considerably better graft survival (90%, 79.5% and 75%) than HCV genotype 1 recipients (66%). As a result of the significant adverse effects of donor age ≥ 70 years on patient and graft survival in hepatitis C positive recipients, we assessed the effect of donor age for younger donors. The deleterious effects of donor age on hepatitis C positive recipient patient and graft survival were significant for donors 60–69 years old within a few years of transplantation and for donors 50−59 years old by 5 years after transplantation (Fig. 3a,b).

Figure 3.

Figure 3

Open in a new tab

(a) Patient survival by donor age for hepatitis C positive recipients (P = 0.0008). (b) Graft survival by donor age for hepatitis C positive recipients (P < 0.0001)

Advanced donor age did not have any detrimental effects on patient or graft survival for hepatitis C negative recipients. Patient and graft survival for hepatitis C negative patients receiving livers from septuagenarian donors (n = 71) and octogenarian donors (n = 28) were similar to those for hepatitis C negative patients receiving livers from younger donor age groups (Fig. 4a,b).

Figure 4.

Figure 4

Open in a new tab

(a) Patient survival by donor age for hepatitis C negative recipients (P = 0.13). (b) Graft survival by donor age for hepatitis C negative recipients (P = 0.24)

Discussion

Our experience accounted for 109 of the 2563 (4.3%) donors older than 70 years and 28 of the 365 (7.7%) donors older than 80 years transplanted in the United States between 1 July 1998 and 31 December 2010 (Scientific Registry of Transplant Recipients, individual data request March 2013). Our results show that use of livers from septuagenarian and octogenarian deceased donors for selected recipients did not have an adverse effect on long-term patient or graft survival, provided that the recipients did not have hepatitis C. Long-term patient and graft survival for hepatitis C positive recipients of older donor livers were less than half that for hepatitis C negative patients and hepatitis positive C patients who received younger donor livers.

Older donor age is well recognized as having an adverse effect on outcome after liver transplantation. A multitude of previous studies have shown an adverse effect on outcome after transplantation attributable to advanced donor age,2–7,10–12 and the effect is even more marked for recipients with hepatitis C.6,7,13,14 Our study corroborates these findings.

Mutimer et al.4 evaluated the effect of donor age using a large European database. Although the strongest negative impact of donor age (over 60 years) was for hepatitis C recipients, older donor age also adversely affected survival of alcoholic cirrhosis patients without hepatitis C. Lake et al.15 evaluated 11 760 liver transplants performed in the United States between 1995 and 2001. In this large registry study, donor age older than 60 years was the strongest negative predictive factor for patients both with and without hepatitis C. Interestingly, survival for hepatitis B patients was not adversely affected by donor age older than 60 years. Few studies have evaluated long-term outcomes of transplantation specifically for livers from donors ≥ 70 years. Cuende et al.3 evaluated 5150 liver transplants in a Spanish registry. Donor age ≥ 70 years was the most significant negative predictor of survival of the 52 donor variables included in the study. However, outcomes were not stratified by recipient hepatitis C status. Similar results have been reported by others.2,16 Reports on long-term outcomes with the use of octogenarian donors are scarce and limited to small series and case presentations.16–18 A multicentre Italian study evaluated outcomes for 30 recipients of octogenarian donor livers. Although follow-up was shorter than 5 years for most of the cohort, 5 out of 13 hepatitis C positive patients who received octogenarian livers died from aggressive hepatitis C recurrence.13

Contrary to other studies, we did not observe a significant adverse effect on survival associated with transplantation of livers from donors ≥ 70 years in hepatitis C negative patients. Indeed, the use of livers from septuagenarian and octogenarian donors did not lead to an increased number of immediate post-transplant complications. Similarly, the use of old livers did not impair long-term patient or graft survival. We report 77% 7-year patient survival and 65% 7-year graft survival for hepatitis C negative recipients of livers from septuagenarian and octogenarian donors. Our results indicate that mild macrosteatosis does not have a detrimental effect on older donor liver graft.

Several factors may account for our excellent results with older donor livers, including careful recipient selection. We chose patients that could tolerate temporary graft dysfunction and for whom we did not expect difficult operations. We usually avoided the use of older livers for critically ill patients. Recipients of livers from old donors were older than recipients of young livers as that was our intent. We tried to match older organs on to older recipients whenever possible. Although advanced recipient age is an adverse prognostic factor for decreased patient survival, the 3-year difference on median recipient age did not lead to inferior survival for recipients of older livers. This observation should be viewed as a protective bias to our favourable outcomes among recipients of older livers. Livers from older donors may be more susceptible to prolonged ischaemic times19–23 and prolonged cold ischaemia time was avoided by our selection and timing efforts. We also attempted to minimize organ cold ischaemia time by avoiding technically complex operations and occasionally starting transplant operations prior to arrival of the donor organ. The reason why cold ischaemia times were similar between the older and younger donor groups was that more of our older donor livers were imported from other organ procurement organizations and cold ischaemia times were prolonged as a result of transportation. We acknowledge that other single centre, multiple centre and registry studies show an adverse effect of older donor age on patient and graft survival for patients without hepatitis C. Our interpretation of our findings is that we were able to achieve excellent patient and graft survival with older donor livers owing to careful patient selection. We do not believe that it is appropriate to use older donors indiscriminately as they become available for patients awaiting transplantation. These livers should still be avoided for patients high on the waiting list that are likely to receive a better graft in the near future. Clinical judgement is necessary to identify patients lower on the waiting list that are at a greater risk of death and disease progression – patients that would benefit from earlier transplantation with an older donor liver, in spite of the potential for increased risks for graft dysfunction and graft failure. Occasionally, it is necessary to use an older donor liver for a critically ill patient that might not survive until a better graft becomes available, but we do believe that outcome is less than we would expect with a younger donor graft.

In contrast to our excellent results in patients without hepatitis C, the outcome for hepatitis C recipients of older donor livers was very poor. Ten patients with hepatitis C received livers from donors ≥70 years, and patient and graft survival were less than half that observed for other patients. There were a multitude of reasons that these hepatitis C patients received older donor livers, including critical illness, severe debility, high risk for death or malignancy progression or a low likelihood of receiving a younger donor liver. Based on our experience and the experiences reported by others, we no longer use older donor livers for hepatitis C patients. Not only is the outcome poor, but a hepatitis C negative patient with a much better prognosis is deprived of an opportunity to receive the older donor liver.

In conclusion, the use of deceased donor livers from septuagenarian and octogenarian donors can provide excellent long-term patient and graft survival for selected patients without hepatitis C. These older donor livers should not be used for patients with hepatitis C owing to a prohibitively high rate of recurrent hepatitis C leading to graft loss and patient death. Our results should provide guidance for other centres considering utilization of livers from deceased septuagenarian and octogenarian donors. Our results should also provide encouragement for organ procurement organizations to be more enthusiastic about working up and placing older donor livers as there are many patients that would benefit from them.

Acknowledgments

The authors would like to thank Ms Jane M. Fasbender for the assistance with providing data to build our study databank. We also would like to thank Dr Andrew Bentall for assistance on matching initial data tables.

Conflicts of interest

None declared.

References

  1. Thuluvath PJ, Guidinger MK, Fung JJ, Johnson LB, Rayhill SC, Pelletier SJ. Liver transplantation in the United States, 1999–2008. Am J Transplant. 2010;10:1003–1019. doi: 10.1111/j.1600-6143.2010.03037.x. [DOI] [PubMed] [Google Scholar]
  2. Busquets J, Xiol X, Figueras J, Jaurrieta E, Torras J, Ramos E, et al. The impact of donor age on liver transplantation: influence of donor age on early liver function and on subsequent patient and graft survival. Transplantation. 2001;27:1765–1771. doi: 10.1097/00007890-200106270-00011. [DOI] [PubMed] [Google Scholar]
  3. Cuende N, Miranda B, Canon JF, Garrido G, Matesanz R. Donor characteristics associated with liver graft survival. Transplantation. 2005;27:1445–1452. doi: 10.1097/01.tp.0000158877.74629.aa. [DOI] [PubMed] [Google Scholar]
  4. Mutimer DJ, Gunson B, Chen J, Berenguer J, Neuhaus P, Castaing D, et al. Impact of donor age and year of transplantation on graft and patient survival following liver transplantation for hepatitis C virus. Transplantation. 2006;15:7–14. doi: 10.1097/01.tp.0000188619.30677.84. [DOI] [PubMed] [Google Scholar]
  5. Kim DY, Moon J, Island ER, Tekin A, Ganz S, Levi D, et al. Liver transplantation using elderly donors: a risk factor analysis. Clin Transplant. 2011;25:270–276. doi: 10.1111/j.1399-0012.2010.01222.x. [DOI] [PubMed] [Google Scholar]
  6. Selzner M, Kashfi A, Selzner N, McCluskey S, Greig PD, Cattral MS, et al. Recipient age affects long-term outcome and hepatitis C recurrence in old donor livers following transplantation. Liver Transpl. 2009;15:1288–1295. doi: 10.1002/lt.21828. [DOI] [PubMed] [Google Scholar]
  7. Aguilera V, Ponce M, Berenguer M, Moreno R, Rayon JM, Sanjuan F, et al. Old donors in liver transplantation for chronic hepatitis C. Rev Esp Enferm Dig. 2007;99:581–587. doi: 10.4321/s1130-01082007001000004. [DOI] [PubMed] [Google Scholar]
  8. Kim DY, Cauduro SP, Bohorquez HE, Ishitani MB, Nyberg SL, Rosen CB. Routine use of livers from deceased donors older than 70: is it justified? Transpl Int. 2005;18:73–77. doi: 10.1111/j.1432-2277.2004.00017.x. [DOI] [PubMed] [Google Scholar]
  9. Emre S, Schwartz ME, Altaca G, Sethi P, Fiel MI, Guy SR, et al. Safe use of hepatic allografts from donors older than 70 years. Transplantation. 1996;62:62–65. doi: 10.1097/00007890-199607150-00013. [DOI] [PubMed] [Google Scholar]
  10. Grande L, Matus D, Rimola A, Manyalic M, Cabrer C, Garcia-Valdecasas JC, et al. Expanded liver donor age over 60 years for hepatic transplantation. Clin Transpl. 1998:297–301. [PubMed] [Google Scholar]
  11. Tector AJ, Mangus RS, Chestovich P, Vianna R, Fridell JA, Milgrom ML, et al. Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival. Ann Surg. 2006;244:439–450. doi: 10.1097/01.sla.0000234896.18207.fa. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Busuttil RW, Farmer DG, Yersiz H, Hiatt JR, McDiarmid SV, Goldstein LI, et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Ann Surg. 2005;241:905–916. doi: 10.1097/01.sla.0000164077.77912.98. ; discussion 16–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Nardo B, Masetti M, Urbani L, Caraceni P, Montalti R, Filipponi F, et al. Liver transplantation from donors aged 80 years and over: pushing the limit. Am J Transplant. 2004;4:1139–1147. doi: 10.1111/j.1600-6143.2004.00472.x. [DOI] [PubMed] [Google Scholar]
  14. Wali M, Harrison RF, Gow PJ, Mutimer D. Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C. Gut. 2002;51:248–252. doi: 10.1136/gut.51.2.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lake JR, Shorr JS, Steffen BJ, Chu AH, Gordon RD, Wiesner RH. Differential effects of donor age in liver transplant recipients infected with hepatitis B, hepatitis C and without viral hepatitis. Am J Transplant. 2005;5:549–557. doi: 10.1111/j.1600-6143.2005.00741.x. [DOI] [PubMed] [Google Scholar]
  16. Cuende N, Grande L, Sanjuan F, Cuervas-Mons V. Liver transplant with organs from elderly donors: Spanish experience with more than 300 liver donors over 70 years of age. Transplantation. 2002;73:1360. doi: 10.1097/00007890-200204270-00033. [DOI] [PubMed] [Google Scholar]
  17. Jimenez Romero C, Moreno Gonzalez E, Colina Ruiz F, Palma Carazo F, Loinaz Segurola C, Rodriguez Gonzalez F, et al. Use of octogenarian livers safely expands the donor pool. Transplantation. 1999;68:572–575. doi: 10.1097/00007890-199908270-00021. [DOI] [PubMed] [Google Scholar]
  18. Zapletal C, Faust D, Wullstein C, Woeste G, Caspary WF, Golling M, et al. Does the liver ever age? Results of liver transplantation with donors above 80 years of age. Transplant Proc. 2005;37:1182–1185. doi: 10.1016/j.transproceed.2004.11.056. [DOI] [PubMed] [Google Scholar]
  19. Grazi GL, Cescon M, Ravaioli M, Ercolani G, Pierangeli F, D'Errico A, et al. A revised consideration on the use of very aged donors for liver transplantation. Am J Transplant. 2001;1:61–68. doi: 10.1034/j.1600-6143.2001.010112.x. [DOI] [PubMed] [Google Scholar]
  20. Anderson CD, Vachharajani N, Doyle M, Lowell JA, Wellen JR, Shenoy S, et al. Advanced donor age alone does not affect patient or graft survival after liver transplantation. J Am Coll Surg. 2008;207:847–852. doi: 10.1016/j.jamcollsurg.2008.08.009. [DOI] [PubMed] [Google Scholar]
  21. Adam R, Sanchez C, Astarcioglu I, Bismuth H. Deleterious effect of extended cold ischemia time on the posttransplant outcome of aged livers. Transplant Proc. 1995;27:1181–1183. [PubMed] [Google Scholar]
  22. Deschenes M, Forbes C, Tchervenkov J, Barkun J, Metrakos P, Tector J, et al. Use of older donor livers is associated with more extensive ischemic damage on intraoperative biopsies during liver transplantation. Liver Transpl Surg. 1999;5:357–361. doi: 10.1002/lt.500050501. [DOI] [PubMed] [Google Scholar]
  23. Wall WJ. Predicting outcome after liver transplantation. Liver Transpl Surg. 1999;5:458–459. doi: 10.1002/lt.500050511. [DOI] [PubMed] [Google Scholar]

Articles from HPB : The Official Journal of the International Hepato Pancreato Biliary Association are provided here courtesy of Elsevier

RESOURCES