Reports on patient and graft survival in liver allograft recipients have been mixed, with some centers reporting very good survival rates. Most notably, however, these findings have not been confirmed by doctors in North America (United Network of Organ Sharing) or Europe (European Liver Transplantation Registry).
In an attempt to make sense of this conflicting evidence, James Neuberger and colleagues at the Liver Unit of the Queen Hospital in Birmingham, England, have reviewed their experience of liver transplant in older recipients and compared their clinical outcome to that of a younger group.
The researchers conducted retrospective analyses of 875 adult patients who underwent liver transplants for chronic disease between 1990 and 1999.
Patients who were included in the study were separated into two groups, consisting of patients under 60 years of age (Group I, n = 701), and patients over 60 years (Group II, n = 174).
|Patient survival after liver transplant is better in the young.|
The study found that the proportion of older patients transplanted increased from just over 10% between 1990 and 1991 to nearly 21% in the period from 1997 to 1999.
Actuarial graft survival at 1, 3, and 5 years was 78%, 74%, and 69%, for Group I. This compared to values of 78%, 73%, and 66%, respectively, for Group II.
The overall actuarial patient survival tended to be better in the younger group (Group I), with 1-, 3-, and 5-year survival rates all higher than for Group II.
Crude mortality probability showed a stable trend until 45 years, a gradual increase between 45 and 60 years, with the risk of death then accelerating.
The same analysis showed the risk of death to be between 1.5- and 2-times greater in Child C patients, with an even more pronounced risk in patients over 66 years of age.
The results of the study suggest that there is no statistically significant difference in either patient or graft survival in patients aged over 60, compared to younger recipients.
The research group concludes, however, that when age is assessed as a continuous variable, an adverse effect of older age is seen on outcome, with this effect being more marked in sicker patients.