Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2001 Jan;233(1):107-13.
doi: 10.1097/00000658-200101000-00016.

The elderly liver transplant recipient: a call for caution

M F Levy  1 , P S Somasundar, L W Jennings, G J Jung, E P Molmenti, C G Fasola, R M Goldstein, T A Gonwa, G B Klintmalm
Affiliations

The elderly liver transplant recipient: a call for caution

M F Levy et al. Ann Surg. 2001 Jan.

Abstract

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 undertaken 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 database of 1,446 consecutive liver transplant recipients was conducted. The 241 elderly patients (older than 60 years) were compared with their younger counterparts by preoperative laboratory values, illness severity, nutritional status, and donor age. Survival data were stratified and logistic regression analyses were conducted.

Results: Elderly patients with better-preserved hepatic synthetic function or with lower pretransplant serum bilirubin levels fared as well as younger patients. Elderly patients who had poor hepatic synthetic function or high bilirubin 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 bilirubin level were independent risk factors for poorer outcome.

Conclusions: Low-risk elderly patients fare as well as younger patients after liver transplantation. However, unless results can be improved, high-risk patients older than 60 years should probably not undergo liver transplantation.

PubMed Disclaimer

Figures

None
Figure 1. Patient survival by age group.
None
Figure 2. (A) Patient survival by age group vs. pretransplant location (home, hospital, intensive care unit). (B) Patient survival for those younger than 60: inpatient (hospital or intensive care unit) vs. outpatient (home). (C) Patient survival by age group: inpatients (hospital or intensive care unit before the transplant).
None
Figure 3. Patient survival by age group and pretransplant bilirubin level.
None
Figure 4. Patient survival by age group and pretransplant albumin level.
None
Figure 5. Patient survival by age group and pretransplant prothrombin time.
None
Figure 6. Patient survival by age group and Child-Pugh score.
See this image and copyright information in PMC

References

    1. United Network for Organ Sharing. 1998 annual report, Richmond, Virginia. Federal Register 1998; 63 (63): 16295–16338.
    1. Federal Register. April 1998.
    1. Markmann JF, Gornbein J, Markowitz JS,et al. A simple model to estimate survival after retransplantation of the liver. Transplantation 1999; 67: 422–430. - PubMed
    1. Rosen HR, Madden JP, Martin P. A model to predict survival following liver retransplantation. Hepatology 1999; 29: 365–370. - PubMed
    1. Shaw BW Jr. Transplantation in the elderly patient. Surg Clin North Am 1994; 74: 389–400. - PubMed

LinkOut - more resources