AGE AND LIVER-TRANSPLANTATION - A REPORT OF THE LIVER-TRANSPLANTATIONDATABASE

Background. The average age of liver transplant recipients has increas ed steadily during the last decade. The effects of recipient age on ou tcome of liver transplantation were evaluated in a large prospective d atabase. Methods. A total of 735 adult recipients of single-organ live r transplants for nonfulminant liver disease enrolled in a large prosp ective database between 1990 and 1994 were analyzed for associations o f patient age with outcomes. Patients were categorized into two groups : younger being <60 and older being greater than or equal to 60 years of age. Results. Older liver transplant recipients were more likely to be female, white, and have the diagnoses of primary biliary cirrhosis or cryptogenic cirrhosis than younger recipients, who were more likel y to have the diagnosis of alcoholic liver disease. Disease severity w as similar between the two groups. After transplantation, the duration s of stay in the intensive care unit and hospital were longer for olde r than for younger transplant recipients, but episodes of acute reject ion were less frequent. The quality of life at 1 year was similar amon g older and younger recipients, Patient survival was lower for older t han for younger recipients (81% vs. 90% at 1 year; P=0.004), whereas g raft survival was not different (80% vs. 85% at 1 year; P=0.163), The excess mortality among older recipients was largely due to nonhepatic causes, including infectious, cardiac, and neurological diseases occur ring within 6 months after transplantation. Conclusions. Although pati ent survival was significantly lower among liver transplant recipients above the age of 60 years, the excess mortality was due to nonhepatic , largely age-related problems. The overall success of liver transplan tation and improvement in quality of life for older recipients is exce llent.