[Liver transplantation in aged patients].

Area of Science:

• Hepatology
• Transplantation Medicine
• Geriatrics

Context:

• Rising incidence of chronic liver disease in aging populations.
• Increasing number of patients over 65 requiring liver transplantation.
• Growing use of older donor organs ('marginal organs') due to organ shortage.

Purpose:

• To assess the feasibility and outcomes of liver transplantation in elderly recipients.
• To highlight the importance of structured interdisciplinary evaluation and prehabilitation for older patients.
• To address the challenges and ethical considerations associated with using elderly donors and recipients.

Summary:

• Patient age is not an absolute contraindication for liver transplantation; careful assessment is key.
• Individualized prehabilitation can minimize perioperative risks in older recipients.
• Postoperative morbidity in carefully evaluated aged patients is comparable to younger counterparts, with a survival advantage over conservative treatment.
• Pharmacological considerations, including polypharmacy and drug interactions, are crucial in long-term care.
• Older donor organs increase risks like ischemia-reperfusion injury, complicating decision-making.

Impact:

• Liver transplantation offers a survival benefit for elderly patients with liver disease compared to non-surgical options.
• Careful patient selection and management can lead to successful outcomes in older liver transplant recipients.
• The study underscores the need for tailored approaches to manage the complexities of aging in both donors and recipients within transplantation medicine.