1Department of Medicine and Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada.
Older donor age is associated with lower graft and patient survival among all liver transplant (LT) recipients. Among patients with hepatitis C (HCV), donor age is one of the strongest predictors of fibrosis severity and graft loss. We evaluated the implementation of a donor age restriction policy among for HCV LT patients at a single center and the effect this policy had on wait-list (WL) and post-LT outcomes of HCV and non-HCV patients. This is a cohort study of 2,388 WL and 1,015 LT recipients from 03/2002 and 01/2013, reflecting three different eras of donor age polices. With donor age restriction, the median donor age was reduced in HCV vs. non-HCV LT recipients (30 years vs. 48 years respectively, P < .001) without differences in WL time (10.6 vs. 8.0 months respectively, P=0.231). Using competing risks regression, those with and without HCV on the WL during the donor age restriction era had a lower sub-hazard of drop-out or death compared to the era without (SHR 0.675, P < .001 and SHR 0.628, P=0.01 respectively). No differences were seen in early post-LT survival in patients with or without HCV between eras (P=0.696 and P=0.883 respectively). We show that donor age restriction for HCV results in lower donor age for HCV recipients without obvious adverse WL consequences. While additional studies are needed, our results demonstrate the feasibility of donor age restriction for LT recipients with HCV and such information may be relevant to programs with limited access to new antiviral therapies for whom modifying risk of severe disease remains of paramount importance.