With an ever-increasing aging general population, older adults have the potential to contribute to an expansion of the donor pool. Organs from older donors are typically underused, despite the present shortage of donors. Historically, liver grafts from older donors have been associated with graft loss and increased recipient mortality, thus deterring their use. In this retrospective cohort study, outcomes of graft discard, graft loss and mortality were assessed in 4127 liver grafts from older donors and 3350 liver-only recipients of older donor grafts and compared to outcomes observed in 78,990 liver grafts from younger donors and 64,907 liver-only recipients of younger donor grafts. Researchers found that liver graft discard from older donors increased from 2003-2016, while mortality rates among recipients from both older and younger donors improved after liver transplant. When comparing mortality rates for recipients of grafts in 2003-2009 with recipients in 2010-2019, investigators found greater improvements in mortality occurring for recipients of grafts from older donors (p=0.04 for interaction). Recipients who received grafts from older donors in 2010-2016 had a 41% lower mortality risk than recipients in 2003-2009 (HR 0.59, 95% CI 0.52 to 0.68, p<0.001), while mortality among recipients of grafts from younger donors improved by 31% (HR 0.69, 95% CI 0.66 to 0.71, p<0.001). In terms of graft loss, graft loss for recipients of liver grafts improved in 2010-2016 compared to 2003-2009, with greater improvements for liver grafts from older donors. From 2010-2016, recipients of liver grafts from older donors had a 40% reduced risk of graft loss (HR 0.60, 95% CI 0.53 to 0.68, p<0.001), while recipients of grafts from younger donors had a 30% improvement of graft loss (HR 0.70, 95% CI 0.68 to 0.72, p<0.001). Taken together, the results from this study suggest that despite decreased use of liver grafts from older donors, there has been an overall improvement in all-cause graft loss and mortality among recipients of liver grafts from older donors. This study is limited in that it could not assess whether the improvement in outcomes correlated with improved post-transplant care or candidate selection for older donors.
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