Systematic review and meta-analysis of liver transplantation using grafts from deceased donors aged over 70 years

Introduction: Due to the current organ shortage, nearly 20% of patients die waiting for a liver transplant (LT). The average donor age is on the rise, and grafts from elderly donors are offered as extended criteria grafts. Methods: This is a meta-analysis comparing the outcome differences of adult patients undergoing LT using grafts from <70-year-old donors vs >70-year-old donors. The primary end-points were graft and patient survival. Secondary outcomes were biliary and vascular complications as well as graft function. The odds ratio (OR) is a summary statistic with the corresponding 95% confidence interval; P <.05 was considered to be statistically significant. Results: Eight nonrandomized comparative studies with 4376 LT recipients were included. About 79.9% and 20.1% of the grafts were from <70-year-old and >70-year-old donors, respectively. Graft survival at 1 year was similar between the two groups (P =.11), but there was better 3-year and 5-year graft survival in the >70-year-old group (P =.006 and P <.0001, respectively). Patient survival was also similar between the groups at 1 year (P =.54), but with better survival at 3-year and 5-year follow-ups (P =.007 and P <.0001, respectively) in the >70-year-old group. There were no statistically significant differences in the incidence of biliary, vascular, and graft functional-related complications. Conclusion: Liver grafts from selected >70-year-old donors do not pose added organ-specific risks and thus have comparable transplantation outcomes.