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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2016; 22(21): 4966-4976
Published online Jun 7, 2016. doi: 10.3748/wjg.v22.i21.4966
How important is donor age in liver transplantation?
Alberto Lué, Estela Solanas, Pedro Baptista, Sara Lorente, Juan J Araiz, Agustin Garcia-Gil, M Trinidad Serrano
Alberto Lué, Sara Lorente, M Trinidad Serrano, Liver Transplantation Unit, Department of Gastroenterology, University Hospital Lozano Blesa, 50009 Zaragoza, Spain
Alberto Lué, Estela Solanas, Pedro Baptista, Sara Lorente, Agustin Garcia-Gil, M Trinidad Serrano, Health Research Institute of Aragon (IIS), 50009 Zaragoza, Spain
Pedro Baptista, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CiberEHD), 28029 Madrid, Spain
Juan J Araiz, Transplant Coordination, University Hospital Lozano Blesa, 50009 Zaragoza, Spain
Agustin Garcia-Gil, Liver Transplant Unit, Department of Surgery, University Hospital Lozano Blesa, 50009 Zaragoza, Spain
Author contributions: Lué A, Solanas E, Baptista P and Serrano MT wrote the paper; Lué A, Solanas E, Lorente S, Araiz JJ, García-Gil A and Serrano MT contributed to data collection; Solanas E, Lorente S, Baptista P and Serrano MT revised and contributed to paper structure.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: M Trinidad Serrano, MD, PhD (Med), Liver Transplantation Unit, Department of Gastroenterology, University Hospital Lozano Blesa, C/San Juan Bosco 15, 50009 Zaragoza, Spain. utra.hcu@salud.aragon.es
Telephone: +34-976-556400 Fax: +34-976-768846
Received: March 20, 2016
Peer-review started: March 22, 2016
First decision: March 31, 2016
Revised: April 15, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 7, 2016
Processing time: 71 Days and 14.1 Hours
Abstract

The age of liver donors has been increasing in the past several years because of a donor shortage. In the United States, 33% of donors are age 50 years or older, as are more than 50% in some European countries. The impact of donor age on liver transplantation (LT) has been analyzed in several studies with contradictory conclusions. Nevertheless, recent analyses of the largest databases demonstrate that having an older donor is a risk factor for graft failure. Donor age is included as a risk factor in the more relevant graft survival scores, such as the Donor Risk Index, donor age and Model for End-stage Liver Disease, Survival Outcomes Following Liver Transplantation, and the Balance of Risk. The use of old donors is related to an increased rate of biliary complications and hepatitis C virus-related graft failure. Although liver function does not seem to be significantly affected by age, the incidence of several liver diseases increases with age, and the capacity of the liver to manage or overcome liver diseases or external injuries decreases. In this paper, the importance of age in LT outcomes, the role of donor age as a risk factor, and the influence of aging on liver regeneration are reviewed.

Keywords: Liver transplantation; Liver regeneration; Graft survival; Old donor; Aging

Core tip: Because of a donor shortage, the use of grafts from old donors has become widespread. Donor age is related to worse outcomes after liver transplantation, higher rates of graft failure, biliary complications and a worse graft survival. In recipients with hepatitis C, the impact of donor age is even more evident. Aging-related changes at the hepatocellular level may contribute to a decreased capacity of the liver to manage or overcome liver diseases and injuries. This review summarizes the evidence regarding the impact of donor age on liver transplantation outcomes.