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Effect of Using Older Donor Grafts on Short- and Medium-Term Survival

M. B. Majella Doyle, MD; Christopher D. Anderson, MD; Neeta Vachharajani, MD; Jeffrey A. Lowell, MD; Surendra Shenoy, MD; Mauricio Lisker-Melman, MD; Kevin Korenblat, MD; Jeffrey S. Crippin, MD; William C. Chapman, MD

Arch Surg. 2008;143:679-685.

Hypothesis  Older donor grafts will provide suitable results of liver transplant, even in recipients with hepatitis C virus (HCV). Although HCV remains the leading indication for liver transplant in adults in the United States, it is associated with HCV recurrence, increased graft loss, and reduced survival. In addition, recent studies suggest that the use of older donors in recipients with HCV is associated with significantly worsened short- and long-term survival.

Design  Prospective database analysis.

Setting  Washington University School of Medicine.

Patients  Between January 1, 1997, and June 30, 2006, a total of 579 liver transplants were performed. Ninety pediatric transplants were excluded. Of the remaining 489 adult patients (84.5%), 187 (38.2%) had HCV and 302 (61.8%) had other indications.

Main Outcome Measures  Patient and graft survival, recurrence of HCV, and need for and results of retransplant.

Results  At 1, 3, and 5 years, overall patient survival was 88.1%, 78.3%, and 69.2%, respectively, and graft survival was 85.6%, 75.6%, and 65.6%, respectively, in patients with HCV. There was no significant difference in patient or graft survival between patients with and those without HCV. Recurrent HCV with clinically significant disease was 20% at 1 year and 62% at 10 years. Seventy-two patients received transplants from donors 60 years or older (24 of 187 [12.8%] with HCV and 48 of 302 [15.9%] without HCV). No difference was demonstrated in short- or medium-term patient or graft survival in recipients of grafts from older donors.

Conclusion  The increasing use of marginal donors, including carefully selected older donors, does not seem to adversely affect short- or medium-term results and may be a source of additional organs for expanding liver transplant waiting lists.

Author Affiliations: Section of Abdominal Transplantation, Department of Surgery (Drs Doyle, Anderson, Vachharajani, Lowell, Shenoy, and Chapman), and Division of Gastroenterology, Department of Medicine (Drs Lisker-Melman, Korenblat, and Crippin), Washington University School of Medicine, St Louis, Missouri.