Survival benefit of accepting livers from deceased donors over 70 years old

Christine E. Haugen, Mary G. Bowring, Courtenay M. Holscher, Kyle R. Jackson, Jacqueline Garonzik-Wang, Andrew M. Cameron, Benjamin Philosophe, Mara McAdams-DeMarco, Dorry L. Segev

Research output: Contribution to journalArticlepeer-review

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:0.450.520.59, P <.001) compared to those who declined the same offer, especially among the highest MELD (35-40) candidates (aHR:0.100.240.55, 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.

Original languageEnglish (US)
Pages (from-to)2020-2028
Number of pages9
JournalAmerican Journal of Transplantation
Volume19
Issue number7
DOIs
StatePublished - Jul 2019

Keywords

  • Scientific Registry for Transplant Recipients (SRTR)
  • clinical research/practice
  • donors and donation: deceased
  • donors and donation: extended criteria
  • liver transplantation/hepatology
  • organ acceptance

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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