Premium
Survival benefit of accepting livers from deceased donors over 70 years old
Author(s) -
Haugen Christine E.,
Bowring Mary G.,
Holscher Courtenay M.,
Jackson Kyle R.,
GaronzikWang Jacqueline,
Cameron Andrew M.,
Philosophe Benjamin,
McAdamsDeMarco Mara,
Segev Dorry L.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15250
Subject(s) - medicine , cirrhosis , liver transplantation , demography , surgery , gerontology , transplantation , sociology
Livers from older donors ( OLD s; age ≥70) are risky and often declined; however, it is likely that some candidates will benefit from OLD s versus waiting for younger ones. To characterize the survival benefit of accepting OLD grafts, we used 2009‐2017 SRTR data to identify 24 431 adult liver transplant ( LT ) candidates who were offered OLD grafts eventually accepted by someone. Outcomes from the time‐of‐offer were compared between candidates who accepted an OLD graft and matched controls within MELD ± 2 who declined the same offer. Candidates who accepted OLD grafts (n = 1311) were older (60.5 vs. 57.8 years, P < .001), had a higher median MELD score (25 vs. 22, P < .001), and were less likely to have hepatitis C cirrhosis (14.9% vs. 31.2%, P < .001). Five‐year cumulative mortality among those who accepted versus declined the same OLD offer was 23.4% versus 41.2% ( P < .001). Candidates who accepted OLD s experienced an almost twofold reduction in mortality ( aHR : 0.45 0.52 0.59 , P < .001) compared to those who declined the same offer, especially among the highest MELD (35‐40) candidates ( aHR : 0.10 0.24 0.55 , P = .001). Accepting an OLD offer provided substantial long‐term survival benefit compared to waiting for a better organ offer, notably among candidates with MELD 35‐40. Providers should consider these benefits as they evaluate OLD graft offers.