BACKGROUND: Multiple studies have shown good results with the use of octogenarian donors in non-HCV recipients and its use is universally accepted worldwide. There are no studies analyzing differences between hepatitis C virus (HCV) and non-HCV recipients transplanted with donors≥80 years in the direct-action antivirals (DAA) period. The rate of liver transplantation (LT) using old donors is still low, and a change in the acceptance of these grafts could increase the liver pool available for LT. MATERIAL AND METHODS: Since the introduction of DAA therapy in our hospital in January 2014 to May 2022, 457 LT were performed, and 74 (16.2%) of these patients underwent LT with donors≥80 years. A cohort study was carried-out comparing 15 HCV-positive recipients vs. 59 HCV-negative patients during the period of the study. RESULTS: Recipients were younger in the non-HCV group. MELD and subsequently DMELD were higher in non-HCV group. Nevertheless, the association of hepatocellular carcinoma (HCC) with HCV cirrhosis was higher than with non-HCV cirrhosis (86.7% vs. 28.8%
p<
0.001), but there were no recurrences within HCV group and only 1 case in the non-HCV group. The 1-, 3-, and 5-years patient and graft survival were similar in both groups. Recipient age and intraoperative transfusion requirements were predictors of graft survival [(HR 1.10, 95CI 1.01-1.21
p=0.03) and (HR 1.03, 95CI 1.01-1.05
p<
0.001), respectively]. CONCLUSIONS: In conclusion, the use of octogenarian donors was a safe alternative to younger donors in HCV recipients requiring LT in the era of DAA with similar results to those obtained in non-HCV patients.