Offer acceptance of older donor liver for transplant lowers mortality risk

Patients with advanced liver disease who accept donor livers from individuals older than 70 years significantly reduced their long-term mortality risk compared with similar patients who declined the same offer regardless of MELD score, according to data presented at the American College of Surgeons Clinical Congress 2018.

“Some surgeons are reluctant to use livers from older donors because they are reluctant to use these organs in high MELD score candidates,” Christine Haugen, MD, lead study author from Johns Hopkins Hospital in Baltimore, Maryland, said in a press release. “We demonstrate that if you get an offer from an older donor, you should probably consider accepting the organ, because there is now a demonstrated survival benefit in doing so.”

Haugen and colleagues analyzed data from the Scientific Registry of Transplant Recipients and included all adult liver transplant candidates who were offered livers between 2009 and 2017 from donors older than 70 years in the study.

They found 1,383 waitlist candidates who accepted a liver from an older patient and 29,142 who declined a similar offer.

Using matched population groups based on MELD scores, Haugen and colleagues found that waitlist candidates who accepted an offer from an older donor had a 61% lower mortality risk compared with those who declined the offer.

“Our primary finding is that regardless of MELD score — that is the 15 to 40 range — there was nearly a twofold decrease in mortality beyond 90 days with acceptance of an older donor,” Haugen said in the release.

Specifically, patients with a MELD score between 29 and 34 had a 60% lower mortality risk, those between 23 and 28 had a 43% lower risk, and those between 15 and 22 had a 56% lower risk.

“The main takeaway is that accepting an older donor confers survival benefits for waitlist candidates across the full range of MELD scores,” Haugen said in the release. “Surgeons should be aware of the consequences of declining an older liver donor for patients with any MELD score. After declining an older donor, you don’t know if a candidate is going to get an offer from another donor. And unfortunately, up to one fourth of these patients will end up dying without ever receiving a transplant.” – by Talitha Bennett

Disclosure: Healio Gastroenterology and Liver Disease was unable to determine the authors’ relevant financial disclosures at the time of publication.