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The elderly liver transplant recipient: a call for caution.
M F Levy1, P S Somasundar, L W Jennings
1Baylor University Medical Center, Transplantation Services, Dallas, Texas 75246, USA. mf.levy@baylordallas.edu.
Annals of Surgery
|January 5, 2001
Summary
Liver transplantation outcomes for patients over 60 depend on their health. Low-risk elderly recipients achieve similar results to younger patients, but high-risk individuals face poorer survival rates.
Area of Science:
- Hepatology
- Transplant Surgery
- Geriatric Medicine
Background:
- Prevailing opinion suggests elderly liver transplant recipients fare well.
- However, some studies show disappointing outcomes in older patients.
- This study reviews liver transplant results in elderly patients at a single center.
Purpose of the Study:
- To determine if liver transplantation is judicious for recipients over 60.
- To identify factors influencing donor liver allocation in elderly patients.
Main Methods:
- Retrospective review of 1,446 liver transplant recipients.
- Comparison of 241 elderly ( >60 years) vs. younger patients.
- Analysis of preoperative lab values, illness severity, nutritional status, and donor age.
Main Results:
- Elderly patients with good hepatic function and low bilirubin survived as well as younger patients.
- High bilirubin, poor hepatic function, or pretransplant hospital admission were linked to lower survival in elderly recipients.
- Recipient age over 60, pretransplant admission, and high bilirubin were independent risk factors for poor outcomes.
Conclusions:
- Low-risk elderly patients have comparable outcomes to younger liver transplant recipients.
- High-risk elderly patients (over 60) with poor prognostic factors may not benefit from liver transplantation unless outcomes improve.