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Our experience in liver transplantation in patients over 65 yr of age
Author(s) -
Bilbao Itxarone,
Dopazo Cristina,
Lazaro Jose Luis,
Castells Luis,
Escartin Alfredo,
Lopez Iñigo,
Sapisochin Gonzalo,
Balsells Joaquin,
Margarit Carlos
Publication year - 2007
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2007.00749.x
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , liver transplantation , odds ratio , surgery , incidence (geometry) , risk factor , transplantation , liver disease , gastroenterology , hepatitis c virus , confidence interval , hepatitis c , virus , immunology , physics , optics
Objectives: The aim of this study was to analyze short‐ and long‐term results of liver transplantation (LT) in patients over 65 yr. Material and methods: Between 1996 and 2004, 386 patients underwent 415 LT at our center. The main indication for LT was post‐necrotic cirrhosis in 59%, followed by hepatocellular carcinoma (HCC) over cirrhosis in 33%. Half of the patients (53%) were hepatitis C virus (HCV) +. Overall, 72 patients were >65 yr of age. Actuarial survival, causes of mortality and postoperative complications were compared between groups: patients under and over 65 yr. Risk factors for poor outcome in patients over 65 yr were also analyzed. Results: The older group had more patients at Child A stage, more HCC as an indication for LT and more HCV (+) patients, p < 0.05. No differences were observed in donor and surgery characteristics, except for lower multi‐transfusion and higher incidence of grafts with steatosis in the older group (p < 0.05). Actuarial survival at one, three, five and 10 yr was 82%, 75%, 72%, and 70% for the <65 yr group vs. 77%, 66%, 55%, and 55% for the >65 yr group (p = 0.03). Main causes of mortality in patients >65 yr were recurrence of underlying disease and medical causes. In the older age group, fewer infections (p = ns) and rejections (p = 0.017) occurred in the postoperative period. Risk factor for poor outcome in the group of patients over 65 yr in multivariate analyses was pre‐LT renal insufficiency (odds ratio 3.5, p = 0.002, 95% confidence interval 1.58–7.82). Conclusion: Results in patients >65 yr are comparable to those <65 yr if older LT candidates are carefully selected. Overimmunosuppression should be avoided in older candidates, as its effects could worsen the pre‐existing diseases common in elderly patients.