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. 2009 Nov;15(11):1481-7.
doi: 10.1002/lt.21865.

Outcome of acute liver failure in the elderly

Frank V Schiødt  1 , Raymond T Chung, Michael L Schilsky, J Eileen Hay, Erik Christensen, William M Lee; Acute Liver Failure Study Group
Collaborators, Affiliations

Outcome of acute liver failure in the elderly

Frank V Schiødt et al. Liver Transpl. 2009 Nov.

Abstract

Older age is considered a poor prognostic factor in acute liver failure (ALF) and may still be considered a relative contraindication for liver transplantation for ALF. We aimed to evaluate the impact of older age, defined as age > or = 60 years, on outcomes in patients with ALF. One thousand one hundred twenty-six consecutive prospective patients from the US Acute Liver Failure Study Group registry were studied. The median age was 38 years (range, 15-81 years). One thousand sixteen patients (90.2%) were younger than 60 years (group 1), and 499 (49.1%) of these had acetaminophen-induced ALF; this rate of acetaminophen-induced ALF was significantly higher than that in patients > or = 60 years (group 2; n = 110; 23.6% with acetaminophen-induced ALF, P < 0.001). The overall survival rate was 72.7% in group 1 and 60.0% in group 2 (not significant) for acetaminophen patients and 67.9% in group 1 and 48.2% in group 2 for non-acetaminophen patients (P < 0.001). The spontaneous survival rate (ie, survival without liver transplantation) was 64.9% in group 1 and 60.0% in group 2 (not significant) for acetaminophen patients and 30.8% in group 1 and 24.7% in group 2 for non-acetaminophen patients (P = 0.27). Age was not a significant predictor of spontaneous survival in multiple logistic regression analyses. Group 2 patients were listed for liver transplantation significantly less than group 1 patients. Age was listed as a contraindication for transplantation in 5 patients. In conclusion, in contrast to previous studies, we have demonstrated a relatively good spontaneous survival rate for older patients with ALF when it is corrected for etiology. However, overall survival was better for younger non-acetaminophen patients. Fewer older patients were listed for transplantation.

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Figures

Figure 1
Figure 1
Overall outcome for all acute liver failure patients.
Figure 2
Figure 2
Age distribution for all patients. Abbreviation: ACM, acetaminophen.
Figure 3
Figure 3
Spontaneous survival rates for patients with an ACM etiology (upper panel) or a non-ACM (lower panel) etiology as a function of age. With linear regression analysis, no trends were found. Abbreviation: ACM, acetaminophen.
Figure 4
Figure 4
Transplantation rates for patients with an ACM etiology (upper panel) or a non-ACM etiology as a function of age. With linear regression analysis, a decrease in transplantation was observed with increasing age. Abbreviation: ACM, acetaminophen.
Figure 5
Figure 5
Survival after transplantation for 48 patients with ACM-induced acute liver failure and for 236 patients with a non-ACM etiology according to age. No significant differences were found. Abbreviations: ACM, acetaminophen; NA, not available; Tx, transplantation.
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