Using Elderly Donors in Liver Transplantation G.L. Grazi, M. Ravaioli, M. Zanello, G. Ercolani, M. Cescon, G. Varotti, M. Del Gaudio, G. Vetrone, A. Lauro, G. Ramacciato, and A.D. Pinna ABSTRACT Aim. Elderly donors are half of the grafts available in our center for liver transplantation. We retrospectively investigated their characteristics, outcomes, and variables related to graft failure. Material and methods. From 1996 to 2003, 540 (46.4%) of 1163 donors were older than 60 years of age and 236 grafts (43.4%) were transplanted, whereas the others were refused. The clinical investigated variables were examined among this cohort. Results. The median age of donors increased from 37 to 62 years. Donors older than 60 years of age were more often refused than younger ones (66% vs 44%); HCV-positive (9.9% vs 5.4%); HbcAb-positive (18.6% vs 12.6%), and steatotic (35.7% vs 13.9%; P  .01). Among donors older than 60 years, the main parameter to refuse the graft was the grade of steatosis. The variables related to the graft loss from donors older than 60 years were as follows: model for end stage liver disease (MELD) recipient 15 (65% vs 39%), cold ischemia time 10 hours (25% vs 13%), high blood losses (3987  4764 vs 2664  2043 mL), and year of liver transplantation after 2000 (26% vs 46%; P  .01). The 1-, 3-, and 5-year graft survival rates were significantly lower among donors older than 60 years than other donors: 75%, 65%, and 62% versus 85%, 83%, and 78%, respectively (P  .001). Conclusion. Donors older than 60 years of age provided liver transplants to half of our recipients. The graft survival rate of these organs was lower than that of younger donors and to improve it the other risk variables for poor outcome should be reduced, including MELD score of the recipient and prolonged cold ischemia time. T HE PROPORTION of organs from donors older than 60 years has been steadily increasing over the past decade, despite their lower graft survival after orthotopic liver transplantation (OLT) compared with organs from younger donors. 1–3 The organ shortage and the growing number of patients listed yearly for OLT substantiate this policy. Surgical strategies to improve the outcome of grafts from donors older than 60 years are advocated, such as the selection of donors according to the presence of steatosis, which is more frequent among older grafts. 1,4 The aim of the study was to investigated the incidence of donors older than 60 years, their outcome, and the variables related to graft failure. MATERIALS AND METHODS From 1996 to 2003, 1163 donor organs were offered for patients with chronic liver disease listed for OLT. Among them, 540 (46.4%) were from donors older than 60 years, including 304 cases not considered suitable for OLT, whereas 236 (43.4%) were used. Clinical parameters were investigated among the following groups: donors 0 – 60 versus 60 years; donors 60 years accepted versus refused; and donors 60 years transplanted graft function- ing versus graft loss. The variables in donors and recipient were as follows: sex, age, HbcAb-positive, HCV-positive, presence of ste- atosis, liver function tests, MELD score, cold ischemia time (CI), blood transfusions, and year of OLT. The graft survival was computed from the date of OLT to the date of graft loss or patient death. Chi-square, Fisher exact, and Student t tests were applied as appropriate. The survival rates were obtained using the Kaplan- Meier method: differences were compared using the log-rank test. From the Liver and Multi-organ Transplant Unit, (G.L.G, M.R., M.Z., G.E., M.C., G.V., M. D. G., G.V., A.L., A.D.P.) Sant’Orsola- Malpighi Hospital, University of Bologna, Bologna, and Depart- ment of Surgery, (G.R.) University La Sapienza, Rome, Italy. Address reprint requests to Gian Luca Grazi, MD, Liver and Multi-Organ Transplant Unit, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. E-mail: glgrazi@unibo.it 0041-1345/05/$–see front matter © 2005 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2005.06.056 360 Park Avenue South, New York, NY 10010-1710 2582 Transplantation Proceedings, 37, 2582–2583 (2005)