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  • Title: Survival benefit of accepting livers from deceased donors over 70 years old.
    Author: Haugen CE, Bowring MG, Holscher CM, Jackson KR, Garonzik-Wang J, Cameron AM, Philosophe B, McAdams-DeMarco M, Segev DL.
    Journal: Am J Transplant; 2019 Jul; 19(7):2020-2028. PubMed ID: 30614634.
    Abstract:
    Livers from older donors (OLDs; age ≥70) are risky and often declined; however, it is likely that some candidates will benefit from OLDs versus waiting for younger ones. To characterize the survival benefit of accepting OLD grafts, we used 2009-2017 SRTR data to identify 24 431 adult liver transplant (LT) candidates who were offered OLD grafts eventually accepted by someone. Outcomes from the time-of-offer were compared between candidates who accepted an OLD graft and matched controls within MELD ± 2 who declined the same offer. Candidates who accepted OLD grafts (n = 1311) were older (60.5 vs. 57.8 years, P < .001), had a higher median MELD score (25 vs. 22, P < .001), and were less likely to have hepatitis C cirrhosis (14.9% vs. 31.2%, P < .001). Five-year cumulative mortality among those who accepted versus declined the same OLD offer was 23.4% versus 41.2% (P < .001). Candidates who accepted OLDs experienced an almost twofold reduction in mortality (aHR:0.45 0.520.59 , P < .001) compared to those who declined the same offer, especially among the highest MELD (35-40) candidates (aHR:0.10 0.240.55 , P = .001). Accepting an OLD offer provided substantial long-term survival benefit compared to waiting for a better organ offer, notably among candidates with MELD 35-40. Providers should consider these benefits as they evaluate OLD graft offers.
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