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Evolving Role of Liver Transplantation in Elderly Recipients
Author(s) -
Mousa Omar Y.,
Nguyen Justin H.,
Ma Yaohua,
Rawal Bhupendra,
Musto Kaitlyn R.,
Dougherty Marjorie K.,
Shalev Jefree A.,
Harnois Denise M.
Publication year - 2019
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25589
Subject(s) - medicine , liver transplantation , proportional hazards model , cohort , transplantation , survival analysis , liver disease , population , surgery , gastroenterology , environmental health
The need for liver transplantation (LT) among older patients is increasing, but the role of LT in the elderly (≥70 years) is not well defined. We retrospectively reviewed all primary LTs from 1998 through 2016 at our center. Survival and associated risk factors were analyzed with Cox regression and Kaplan‐Meier methods for LT recipients in 3 age groups: <60, 60‐69, and ≥70 years. Among 2281 LT recipients, the median age was 56 years (range, 15‐80 years), and 162 were aged ≥70 years. The estimated 5‐ and 10‐year patient survival probabilities for elderly LT recipients were lower (70.8% and 43.6%) than for recipients aged 60‐69 years (77.2% and 64.6%) and <60 years (80.7% and 67.6%). Patient and graft survival rates associated with LT improved over time from the pre–Model for End‐Stage Liver Disease era to Share 15, pre–Share 35, and Share 35 for the cohort overall ( P < 0.001), but rates remained relatively stable in septuagenarians throughout the study periods (all P > 0.45). There was no incremental negative effect of age at LT among elderly patients aged 70‐75 years (log‐rank P = 0.32). Among elderly LT recipients, greater requirement for packed red blood cells and longer warm ischemia times were significantly associated with decreased survival ( P < 0.05). Survival of LT recipients, regardless of age, markedly surpassed that of patients who were denied LT, but it was persistently 20%‐30% lower than the expected survival of the general US population ( P < 0.001). With the aging of the population, select older patients with end‐stage liver diseases can benefit from LT, which largely restores their expected life spans.