39th National Congress of the Italian Society of Organ TransplantationLiver transplantationDo Older Liver Grafts Have Worse Survival? The Niguarda Experience

•Elderly donors are a very important resource in liver transplantation.•Our experience shows non-inferior survival results for elderly grafts allocated to HCC recipients.•Our experience shows inferior survival results for elderly grafts allocated to HCV recipients.•The present scenario will probably change thanks to the anti-HCV drugs and possibly elderly grafts will be allocated without jeopardizing the survival outcomes in the near future.

BackgroundElderly donor livers are thought to be marginal graft. In the present study, we aimed to identify an age threshold to consider a graft as elderly to identify the trend (if any) of the donor age in our series and to identify an efficient allocation criteria for elderly grafts.MethodsWe reviewed in a retrospective manner our series of 1520 liver transplants, comparing graft survival under and over a certain age. On the basis of the results of this analysis, we identified a threshold of 70 years to define a graft as old. The donor age trend analysis showed an increasing rate of transplants from elderly donors.ResultsTo identify efficient allocation criteria for elderly graft, we stratified the series by the disease of the recipient: 556 patients underwent transplants for hepatocellular carcinoma (HCC+ group) and 964 for other diseases (HCC− group). Two hundred twenty-one patients of 556 of the HCC+ group were hepatitis c virus (HCV) negative (HCC+/HCV− group), and 312 of 964 of the HCC− group were HCV positive (HCC−/HCV+). The survival analysis showed no significant differences in comparing the outcome for elderly and young grafts in the HCC+ (P = .135) and HCC− (P = .055) groups.ConclusionsWhen comparing the survival of old and young livers in the HCC+/HCV− group, the elderly livers appear to have a better outcome (P = .05); on the other hand, the same analysis in the HCC−/HCV+ group shows a worse outcome for old-aged grafts (P = .026). Therefore, the present study suggests that elderly livers should be allocated to hepatocellular carcinoma (HCC) patients and should be avoided in HCV+ recipients.