Impact of donor age in donation after circulatory death liver transplantation: Is the cutoff “60” still of relevance?

Background Advanced donor age has been identified as risk factor, when combined with donor warm ischemia, e.g. in donation after circulatory death (DCD). In several countries DCD livers, older than 60 years are not considered suitable due to concerns related to poor graft function and development of ischaemic cholangiopathy. We evaluate in this study outcome after DCD liver transplantation using grafts from donors older than 60 years. Methodology We analysed outcome after DCD liver transplantation (n=315), comparing donors >60 years (n=93) and donors ≤60 years (n=222) from our centre between 2005 and 2015. Endpoints included graft function and complications, patient and graft survival. Multivariate risk analysis was performed to define further key factors that predicted inferior outcome. Results Donor age at the cut-off 60 years failed to stratify patient and graft survival. The rate of vascular, biliary and overall complications was comparably low in both cohorts and the median CCI was 42,7 points, independent from the donor age. Secondly, donor BMI above a threshold of 25 kg/m2 significantly impacted on graft and patient survival, at any donor age, while donor warm and cold ischemia times were not predictive for graft loss. Conclusion Older DCD donors can be successfully used for liver transplantation with good long-term outcomes, when further risk factors are limited. Additional risk is transmitted by an increased donor BMI, regardless of donor age. This article is protected by copyright. All rights reserved.