Impact of different donor age cut-offs on adult recipient survival after liver transplantation: a single-center analysis.

The increasing number of patients awaiting liver transplantation (LT) has forced to use cadaveric donors (CD) with suboptimal characteristics. Of these, donor age is the most investigated parameters. Although excellent outcomes were observed for LT performed by using CD aged >60 years, European Liver Transplant Registry (ELTR) found an increased risk by using CD with >55 years, and the Italian National Transplant Center has recently assumed the CD age >60 years as a potential risk factor for LT. In this study, a single-center analysis has been carried out by stratifying CD for three different age cut-offs (=55/>55, <=60/>60, and =65/>65 years), and then evaluating their effect on LT outcome. Although no significant difference in 6-month and 1-year patient or graft survival occurred after stratification for each donor age cut-off, a better survival was observed in LT performed with livers procured from CD >55 years. A significant increase in cold ischemia time (CIT) was observed in LT performed with grafts procured from CD =55 and =65 years (P = 0.007), and an inverse correlation between overall CIT and donor age occurred (r = -0.300; P = 0.0022). However, no impact on 1-year patient survival was found by introducing in univariate logistic regression models CIT, as well as overall donor age, recipient age, and ELTR diagnostic categories. The results of this study suggests the suitability of CD >55 years for LT, and the need to further investigate the cut-off value for CIT-related increasing risk.