EFFECT OF DONOR AGE AND SEX ON THE OUTCOME OF LIVER-TRANSPLANTATION

We correlated donor and recipient factors with graft outcome in 436 ad ult patients who underwent 462 liver transplants. Donor variables anal yzed were age, gender, ABO blood group, cause of death, length of stay in the intensive care unit, use of pressors or pitressin, need for ca rdiopulmonary resuscitation, terminal serum transaminases, and ischemi a time. Recipient variables analyzed were age, gender, primary diagnos is, history of previous liver transplant, ABO blood group, cytotoxic a ntibody crossmatch, United Network for Organ Sharing (UNOS) status, an d waiting time (except for the cross-match results, they were all know n at the time of the operation). The endpoint of the analysis was graf t failure, defined as patient death or retransplantation. Using multiv ariate analysis, graft failure was significantly associated with donor age, donor gender, previous liver transplantation, and UNOS 4 status of the recipient. The effect of donor age became evident only when the y were older than 45 years. Livers horn female donors yielded signific antly poorer results, with a-year graft survival of female to male 55% (95% CI, 45% to 67%); female to female, 64% (95% CI, 54% to 77%); mal e to male, 72% (95% CI, 66% to 78%); and male to female, 78% (95% CI, 70% to 88%). The only donors identified as questionable for liver proc urement were old (greater than or equal to 60 years) women in whom the adverse age and gender factors were at least additive. However, rathe r than discard even these livers, in the face of an organ shortage cri sis, their individualized use is suggested with case reporting in a sp ecial category.