• Toyonari Kubota, Koichiro Hata, Takashi Sozu, Yoshihide Ueda, Hirofumi Hirao, Yusuke Okamura, Ichiro Tamaki, Junichi Yoshikawa, Jiro Kusakabe, Hirokazu Tanaka, Shoichi Kageyama, Takayuki Anazawa, Atsushi Yoshizawa, Shintaro Yagi, Noriyo Yamashiki, Hideaki Okajima, Toshimi Kaido, and Shinji Uemoto.
• Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan.
• Ann. Surg. 2018 Jun 1; 267 (6): 1126-1133.

ObjectiveTo investigate the influence of donor age on recipient outcome after living-donor partial liver transplantation (LDLT).BackgroundDonor age is a well-known prognostic factor in deceased donor liver transplantation; however, its role in LDLT remains unclear.MethodsWe retrospectively analyzed 315 consecutive cases of primary adult-to-adult LDLT in our center between April 2006 and March 2014. Recipients were divided into 5 groups according to the donor age: D-20s (n = 60); D-30s (n = 72); D-40s (n = 57); D-50s (n = 94); and D-60s (n = 32). The recipient survival and the association with various clinical factors were investigated.ResultsRecipient survival proportions were significantly higher in D-20s compared with all the other groups (P = 0.008, < 0.001, < 0.001, and = 0.006, vs D-30s, -40s, -50s, and -60s, respectively), whereas there was no association between recipient survival and their own age. There are 3 typical relationships between donors and recipients in adult-to-adult LDLT: from child-to-parent, between spouses/siblings, and from parent-to-child. The overall survival in child-to-parent was significantly higher than in spouses/siblings (P = 0.002) and in parent-to-child (P = 0.005), despite significantly higher recipient age in child-to-parent [59 (42-69) years, P < 0.001]. Contrastingly, parent-to-child exhibited the lowest survival, despite the youngest recipient age [26 (20-43) years, P < 0.001]. In addition, younger donor age exhibited significantly better recipient survival both in hepatitis C virus-related and in non-hepatitis C virus diseases. Univariate and multivariate analyses both demonstrated that donor age and graft-type (right-sided livers) are independent prognostic factors for recipient survival.ConclusionsDonor age is an independent, strong prognostic factor in adult-to-adult LDLT.

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