Living-donor liver transplantation using donors older than 50 years of age: Recipient criteria and donor risk: A multicenter study of Japanese Society of Hepato-Biliary-Pancreatic Surgery

Abstract

Background

Few published reports have addressed the feasibility of living-donor liver transplantation (LDLT) using elderly donors. We aimed to examine LDLT outcomes in elderly donors and identify clinical factors impacting safely conducted LDLT.

Methods

This study was conducted in collaboration with the Japanese Society of Hepatobiliary-Pancreatic Surgery. Data were collected from 140 patients who underwent LDLT using donors aged ≥50 years between 2013 and 2017 at nine collaborating hospitals.

Results

The 1-, 3-, and 5-year graft survival rates in recipients after LDLT employing elderly donors were 84.3%, 78.5%, and 76.3%, respectively, with 6-month mortality of 12.1%. Specific recipient-donor age combinations did not emerge as adverse prognostic factors. A total of 32 recipients (22.9%) had major complications requiring reoperation after LDLT, and 15 donors (10.7%) had major complications of Clavien–Dindo grade ≥II. Multivariate analysis revealed that graft-to-recipient weight ratio (GRWR) <0.84% and neutrophil-to-lymphocyte ratio (NLR) >6.6 were independent predictors of 6-month graft loss after LDLT.

Conclusion

LDLT using elderly donors aged ≥50 years has acceptable graft survival and morbidity rates, and donor age >50 years should not be an absolute contraindication for LDLT. In LDLT involving elderly donors, it is crucial to consider that GRWR <0.84% and NLR >6.6 are adverse prognostic factors. Addressing these factors is necessary to enhance the prognosis, aligning with the increasing public demand for this surgical procedure.