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.