DONOR AGE AND OUTCOME OF LIVER-TRANSPLANTATION

To evaluate the effect of donor age on graft and patient outcome after liver transplantation an analysis of a large-scale cohort study was p erformed at three tertiary referral liver transplant centers. Between April 1990 and June 1994, 772 adults underwent an initial single-organ liver transplantion. The age of the donors averaged 35 years; 193 (25 %) were 50 or above, the age used to define ''older'' donors. Groups w ere compared for demographic, clinical, and biochemical features. Outc ome was measured using results of biochemical tests after transplantat ion and by graft and patient survival. Compared with younger donors, o lder donors were more commonly women (59% vs. 33%: P less than or equa l to .001) and died of central nervous system causes (79% vs. 28%) as opposed to trauma (13% vs, 63%: P less than or equal to .001). The rec ipients of the two groups of donor livers did not differ in important respects, However, intraoperatively, livers from older donors were mor e likely to be assessed as either ''poor'' or ''fair'' as opposed to ' 'good'' (17% vs, 4%: P less than or equal to .001) by the harvesting s urgeon and to have initial ''poor'' or ''fair'' bile production (29% v s. 18%: P less than or equal to .001). During the first week postopera tively, the serum aminotransferase and bilirubin levels and prothrombi n times were higher in recipients of older than those of younger donor livers, During followup, graft survival was less for recipients of ol der donor livers at 3 months (81% vs, 91%: P = .0001) and at 1 (76% vs . 85%: P = .007) and 2 years (71% vs, 80%: P = .005); patient survival showed similar though less marked differences, This association of do nor age and poorer graft survival persisted after adjusting for many v ariables using bivariate and multivariate analyses, Importantly, howev er, the association with poor graft survival was largely among recipie nts of older donor Livers, the quality of which was assessed as fair o r poor by the harvesting surgeon; recipients of older donor livers ass essed as good had a retransplant-free survival similar to that of youn ger donor livers (87% vs, 91% at 3 months). Thus, use of older donor l ivers, the quality of which are judged to be good by the harvesting su rgeon, is not associated with a decrease in patient or graft survival after liver transplantation.