LIVER Octogenarian Livers Successfully Transplanted in Patients With Fulminant Hepatic Failure B. Nardo, R. Montalti, P. Beltempo, R. Bertelli, L. Puviani, V. Pacilè, M. Vivarelli, and A. Cavallari ABSTRACT Although octogenarian livers have been transplanted successfully in elective settings, their safety in the case of fulminant hepatic failure has not yet been reported. From November 1998 to June 2003, we transplanted 3 livers from 80-, 82-, and 86-year-old donors. The donors were hemodynamically stable with an intensive care unit stay ranging from 24 – 48 hours. Cold ischemia time was from 260 minutes to 526 minutes. Mild macrosteatosis was present in 2 donors. Donor and recipient characteristics as well as posttransplantation evolution were evaluated. Two cases had uneventful courses and all recipients are well at 39, 21, and 5 months, respectively. The second recipient underwent retransplantation at 15 days due to technical complications. Livers from octogenarian donors may be safely used in an emergency to save patients. Age does not represent a limit for individually assessed and highly selected donors. F ULMINANT hepatic failure (FHF) can be effectively treated with emergency liver transplantation. The prompt availability of an organ determines patient survival with rates of about 60%. 1 In recent years, some reports have disclosed the possibility of using grafts from octoge- narian donors, 2,3 mainly for elective procedures. However, use of grafts from octogenarian donors in emergency set- tings has never been described even from our group. 4 The risk of initial poor function (IPF) or primary graft nonfunc- tion (PGNF) 5 observed with elderly grafts, mainly in the presence of a long ischemic period and steatosis, 6–8 may have prevented them from being considered for emergency transplantation. We report 3 cases of successful emergency liver transplantation on FHF patients using grafts from donors of 80 or more years. From November 1998 to June 2003, 31 livers from donors 80 years or older were referred to our center. Seventeen (17 of 33; 51.6%) grafts were transplanted (14 electively and 3 emergently). The remain- ing 16 (48.4%) livers were discarded due to cirrhosis after hepatitis C virus (HCV)-positivity (n = 3), severe steatosis documented by biopsy (n = 5), hepatitis B virus (HBV)– positivity with hypertransaminasemia (n = 2), malignancies undetected prior to harvesting (n = 3), and hemodynamic instability (n = 1), and 2 were refused for organizational reasons and underwent transplantation in other centers. From the Department of Surgery and Transplantations, S. Orsola Hospital, University of Bologna, Bologna, Italy. Address reprint requests to Prof. Bruno Nardo, Department of Surgery and Transplantations, S. Orsola Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy. E-mail: nardo @aosp.bo.it © 2005 by Elsevier Inc. All rights reserved. 0041-1345/05/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2004.11.063 Transplantation Proceedings, 37, 389 –391 (2005) 389