Outcomes of Donation After Cardiac Death Liver Grafts from Donors ≥ 50 years of Age: A Multi-center Analysis.

INTRODUCTION: As the population in the United States continues to age, an increase in the number of potential DCD donors with advanced chronological age can be expected. The aim of this study was to analyze a multi-institutional experience in liver transplantation using DCD donor age ≥50 years.

METHODS: All DCD LT performed at Mayo Clinic Florida, Mayo Clinic Rochester and Mayo Clinic Arizona from 2002-2016 were included. Recipients of DCD LT were divided into 2 groups: those with donor age ≥50 years(N=155) and those with donor age <50 years(N=316).

RESULTS: Graft survival was similar between the DCD donor age ≥50 group and DCD donor age <50 group(p=0.99). Graft survival at 1-, 3- and 5-years was 87.0%, 75.6% and 71.8% in the DCD donor age ≥ 50 group and 85.8%, 76.0% and 70.4% in the DCD donor age < 50 group.The rate of total biliary complications (32.3%vs.23.7%; p=0.049) and of anastomotic strictures (16.1%vs.8.2%; p=0.01), were higher in the DCD donor age ≥50 compared to the DCD donor age <50 group. No statistical significant difference in the rate of IC (11.6%vs.7.6%; p=0.15) was seen between the 2 groups. Due to homogeneous practice patterns at the involved institutions, additional Cox regression analysis using national data obtained from SRTR was used to evaluate predictors of graft failure in DCD donor age ≥50 years. Significant predictors of graft failure included: a calculated MELD score ≥30 (p<0.001), mechanical ventilation at the time of transplant (p<0.001), medical condition (in ICU) (p=0.002) and CIT (p<0.001).

CONCLUSION: The present study demonstrates that acceptable graft and patient survival can be achieved with the usage of DCD LT with donor age ≥50 years. Optimizing recipient selection criteria and minimizing CIT may further improve outcomes.