The team determined whether liver transplantation is judicious in recipients older than 60 years of age, and has reported their findings in this month's Annals of Surgery.
A retrospective review of a prospectively maintained single-institution database of 1,446 consecutive liver transplant recipients was conducted.
The 241 elderly patients, all older than 60 years, were compared with their younger counterparts by preoperative laboratory values, illness severity, nutritional status, and donor age. Survival data were stratified and logistic regression analyses were conducted.
Independent risk factors for poorer transplant outcome:
- Recipient aged over 60 years
- Pre-transplant hospital admission
- High bilirubin levels
The team found those elderly patients with better-preserved hepatic synthetic function or with lower pre-transplant serum bilirubin levels fared as well as younger patients.
Elderly patients who had poor hepatic synthetic function or high bilirubin levels, or who were admitted to the hospital, had much lower survival rates than the sicker younger patients or the less-ill older patients.
Recipient age 60 years or older, pre-transplant hospital admission, and high bilirubin level were independent risk-factors for poorer outcome.
Dr Marlon Levy concluded that, "Low-risk elderly patients fare as well as younger patients after liver transplantation. However, unless results can be improved, high-risk patients older than 60 years should probably not undergo liver transplantation."