The elderly liver transplant recipient: A call for caution

Objective To determine whether liver transplantation is judicious in recipients older than 60 years of age. Summary Background Data The prevailing opinion among the transplant community remains that elderly recipients of liver allografts fare as well as their younger counterparts, but our results have in some cases been disappointing. This study was under taken to review the results of liver transplants in the elderly in a large single-center setting. A secondary goal was to define, if possible, factors that could help the clinician in the prudent allocation of the donor liver . Methods A retrospective review of a prospectively maintained single-institution dat abase of 1,446 consecutive liver transplant recipients was conducted. The 2 41 elderly patients (older than 60 years) were compared with their younger counterparts by preoperative laboratory values, illness severity, nutrition al status, and donor age. Survival data were stratified and logistic regres sion analyses were conducted. Results Elderly patients with better-preserved hepatic synthetic function or with l ower pretransplant serum bilirubin levels fared as well as younger patients . Elderly patients who had poor hepatic synthetic function or high bilirubi n levels or who were admitted to the hospital had much lower survival rates than the sicker younger patients or the less-ill older patients. Recipient age 60 years or older, pretransplant hospital admission, and high bilirubi n level were independent risk factors for poorer outcome. Conclusions Low-risk elderly patients fare as well as younger patients after liver tran splantation. However, unless results can be improved, high-risk patients ol der than 60 years should probably not undergo liver transplantation.