Background: Due to organ shortage, the use of older donors is an
acceptable option to decrease waiting list mortality. However, survival outcomes of liver transplantation (LT) with octogenarian grafts
remain controversial.
Methods: Data were retrieved from the prospectively maintained
databases of two Italian liver transplant centers (Bergamo and Ancona), including first, adult, non-urgent, ABO-identical LTs from January 2004 to June 2017. LTx with HCV positive and partial liver grafts were
also excluded. Among 732 recipients included, 78 (10.7%) received
an octogenarian graft (Oct-Group) and 654 a standard graft (18-79
years:Std-Group). A propensity score approach with 1:2 match was
applied to balance 12 possible risk factors for graft loss related to
the recipient (LT-year, age, gender, liver disease etiology, presence
of HCC, lab-MELD) and to the donor (gender, cause of death, Na peak,
BMI, anti-HBc positivity, cold ischemia time). Results: Oct-Group recipients were successfully matched with 156
Std-Group patients in terms of donor, recipient and perioperative
characteristics. After a median follow-up of 51 (IQR:20.3-93.4) months,
1- 3- and 5-year patient survival was 85.4%, 75.3% and 71.1% in the
Oct-Group vs 85.7%, 78.6% and 75.1% in the Std-Group, respectively (log-rank p-value:0.283). Five-year graft survival was also similar
(Oct-Group: 69.8% vs 72.9% Std-Group; p-value: 0.423). Early (within 30
days) re-LTx rate (1.3% vs 1.3%; p-value:0.538) and HCV-related deaths
(1.3 vs 2.6%; p-value:0.874) were identical in the two groups. Subgroup
analysis revealed similar 5-year survival outcomes when octogenarian grafts were allocated in HCV positive (54.2% vs 68.1%;p-value:0.224)
or higher (≥25) MELD (67.9% vs 65.2%; p-value:0.831) recipients. After
multivariate analysis, the only independent prognostic factor for
graft loss was a pre-LT MELD-score ≥ 30 [Exp(b):1.92;p-value:0.035].
Conclusions: Use of octogenarian grafts, even when these are allocated to high-risk recipients, is not associated with a worse outcome
