Use of older donor livers is associated with more extensive ischemic damage on intraoperative biopsies during liver transplantation

Initial poor graft function is associated with increased morbidity and graf t loss after liver transplantation. Donor age is a risk factor for the deve lopment of initial poor function. The severity of ischemic damage on intrao perative postreperfusion (OPost) allograft biopsy specimens is predictive o f subsequent initial poor function. This study was performed to assess whet her donor age is a risk factor for the development of ischemic damage on OP ost biopsy specimens. Tt le records of 94 liver transplantations were revie wed. OPost biopsy specimens were obtained after complete allograft revascul arization. The severity of ischemic damage was graded as follows: 0, none; 1, minimal; 2, mild; 3, moderate; and 4, severe. Grafts were defined as old er when donor age was 50 years or older. Other independent variables examin ed included donor cause of death, length of hospital stay, acidosis, serum alanine aminotransferase level, graft cold ischemia time, and degree of ste atosis. Older grafts were associated with higher grades of ischemic; damage than younger grafts (2.3 +/- 1.0 v1.3 +/- 1.1; P =.003). Univariate and mu ltivariate analysis identified donor age of 50 years or older as the only s ignificant predictive variable of the severity of ischemic damage. In 16 tr ansplantations involving older grafts, there was no statistically significa nt association between the severity of ischemic damage and incidence of ini tial poor function and graft loss. The use of older liver grafts is associa ted with more extensive ischemic damage immediately after graft reperfusion . Whether this early lesion identifies among older graft recipients those a t risk for a worst outcome remains to be determined. Copyright (C) 1999 by the American Association for the Study of Liver Diseases.