Here is my highlight from the current issue of HPB.
The disparity between supply and demand of donor livers for transplantation remains an ever-present challenge and drives the use of extended criteria donor organs. Donor age is one criterion that has been moving steadily upwards but changes have often been based on anecdote rather than evidence. In addition much of what we know about using older donor livers relates to short-term outcomes but there is clearly interest in how an already old liver will do in a recipient who may be expected to have a long post-transplant life expectancy. In this edition of HPB, Chedid et al. explore the Mayo Clinic experience of transplanting livers from 70 and 80 year old cadaveric donors. In their experience, 107 donor livers (14 % of the total series) were from this older population. Fewer livers from older donors were transplanted into recipients with hepatitis C, which concurs with their institutional policy based on evidence of better outcomes in hepatitis C recipients for liver transplantation from younger donors. They found no difference in graft or patient survival for the overall population based on donor age being greater or less than 70 years. In the hepatitis C recipients, there was a clear disadvantage both in terms of patient and graft survival to patients receiving a graft from an over 70 years donor. Although there is undoubtedly a need for careful selection of livers in the older populations with the avoidance of steatosis, there is clear evidence of benefit from using older livers from brainstem dead heart-beating donors. The introduction of new effective antiviral therapies for Hepatitis C may negate the observed adverse outcome association of transplanting older livers into hepatitis C recipients. Older individuals in society should be afforded the possibility of donating their livers, where appropriate, as it is clear that recipients will benefit.
The full article is
Excellent long-term patient and graft survival are possible with appropriate use of livers from deceased septuagenarian and octogenarian donors
Article first published online: 28 JAN 2014
© 2014 International Hepato-Pancreato-Biliary Association
Volume 16, Issue 9, pages 852–858, September 2014