Little is known of national utilization practices and outcomes with ≥80y donors. Methods: Using UNOS registry data, all U.S. adult recipients of primary deceased donor LT from 2/05-1/12 were evaluated (n=36,318). Centers (n=132) were categorized based on the # of ≥80y livers transplanted: non- (n=95), low- (n=31, range: 1-7 grafts/center), and high-utilizers (n=6, range: 22-36 grafts/center). Regions (n=11) were categorized as low-, mid-, and high-MELD based on tertiles of median recipient LT-MELD. Cox models evaluated the effects of donor
age ≥80y on graft loss (death or re-LT). Cilomilast purchase Results: 244 ≥80y donor livers were transplanted. Donors ≥80y vs <80y differed by %female (63 vs 40%), %with diabetes (15 vs 11%) and/ or hypertension (73 vs 35%), %died of stroke (75 vs 42%), %donation
ACP-196 manufacturer after cardiac death (0 vs 5%), and %distributed nationally (33 vs 6%) [p<0.01 for all], but not by cold ischemia time (6.7 vs 6.6 hours; p=0.41). Recipients of ≥80y vs <80y livers were older (median 60 vs 55y), more likely to be female (42 vs 32%), less likely to have HCV (11 vs 27%), and had lower median laboratory LT-MELD (17 vs 20) [p<0.01 for all], but were similar for %hepatocellular carcinoma (18 vs 23%; p=0.07). Only 37/132 (28%) centers transplanted ≥80y livers, but 174/244 (71%) of the ≥80y livers were transplanted by 6 centers (high-utilizers), accounting for 2-8% of each center's total transplant volume; 3, 2, and 1 centers were in high-, mid-, and low-MELD regions, respectively. The adjusted hazard ratio (aHR) for graft loss
of ≥80y livers was 1.15 (95% CI 0.93-1.43; p=0.20). Low- and high-utilizers did not differ in graft survival of ≥80y livers (aHR 1.88, 95% CI 0.85-4.13, p=0.12). Overall graft survival of ≥80y vs <80y livers was 88% vs 91% at 3 months selleck inhibitor (p=0.07), 75% vs 79% at 1y (p=0.14), and 48% vs 47% at 3y after LT (p=0.67). Re-LT occurred in 7% and 5% recipients of ≥80y vs <80y livers (p=0.01); %re-LT for ≥80y graft recipients did not differ between low- and high-utilizers (7 vs 7%; p=0.97). Among ≥80y grafts that failed within 1y of LT, only recipient LT-MELD score predicted failure (OR 1.05 per MELD point, 95% CI 1.01-1.09; p=0.03). Conclusion: The vast majority of ≥80y donor livers are accepted and transplanted by only 6 U.S. LT centers. Graft survival with ≥80y livers was acceptable and did not vary by center experience with ≥80y donors. Codification of objective selection criteria may increase utilization of older donors while maintaining the currently observed post-LT outcomes. Disclosures: The following people have nothing to disclose: Suzanne R. Sharpton, Sandy Feng, Jennifer C.