Outcome after liver transplantation in elderly recipients (&gt;65 years) — A single-center retrospective analysis

Kollmann, Dagmar; Maschke, Svenja; Rasoul‐Rockenschaub, Susanne; Baron, David M.; Hofmann, Michael; Silberhumer, Gerd R.; Györi, Georg; Soliman, Thomas; Berlakovich, Gabriela

doi:10.1016/j.dld.2018.06.018

Cited by 11 publications

(4 citation statements)

References 48 publications

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“…Few deceased donor liver transplant (DDLT) centres from the USA and Europe have analysed the outcomes of elderly recipients and have shown conflicting results. [2][3][4][5][6] The literature on outcomes after LDLT in the elderly patients is even more limited. 7 This study will be the first from a resource-constrained country without a robust national health service.…”

mentioning

confidence: 99%

Living Donor Liver Transplant in Patients Aged 60 Years or Older: Experience from a Large Volume Centre in India

Nidoni

Kandagaddala

Agarwal

et al. 2021

Journal of Clinical and Experimental Hepatology

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Background: With ageing population and higher prevalence of nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC) in older patients, more and more living donor liver transplants (LDLTs) are being considered in this group of patients as eligibility for deceased donor liver transplant is restricted to those aged 65 years and younger. However, the short-and long-term outcomes of this group have not been reported from India, which does not have a robust national health scheme. The aim of this study was to provide guidelines for transplant in this group. Methods: All patients aged 60 years and older (group 1) who underwent LDLT in our centre between January 2006 and December 2017 were studied. A propensity score-matched group in 1:2 ratio was created with comparable sex and Model for End-Stage Liver Disease score (group 2). The 2 groups were compared for duration of hospital stay, surgical complications, hospital mortality and 1-, 3-and 5-year survival. Results: Group 1 consisted of 207 patients, and group 2 had 414 patients. The number of patients in group 1 gradually increased with time from 4 in 2006 to 33 in 2017 accounting for 15% of total cases. Group 1 had more patients with viral hepatitis, NASH and HCC, and they had a higher 30-day mortality due to cardiorespiratory complications. Although 1-and 3-year survival was similar, the 5-year survival was significantly lower in group 1. Conclusion: Five-year survival was lower in the elderly group due to cardiorespiratory complications and recurrence of HCC. Outcomes in the elderly group can be improved with better patient selection and preventing HCC recurrence.

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confidence: 99%

Living Donor Liver Transplant in Patients Aged 60 Years or Older: Experience from a Large Volume Centre in India

Nidoni

Kandagaddala

Agarwal

et al. 2021

Journal of Clinical and Experimental Hepatology

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“…There are several single-center or SRTR reports analyzing the impact of recipient age in LT, especially in regard to elderly recipients who were ≥65 years old 3 or ≥70 years old. 4 - 7 A decade ago, a single-center report from the Mayo Clinic showed in a cohort of 42 patients that 5-year mortality and graft loss in elderly recipients (≥70 y) in LT were comparable with those in younger recipients (<60 y).…”

mentioning

confidence: 99%

Impact of Recipient Age in Combined Liver-Kidney Transplantation: Caution Is Needed for Patients ≥70 Years

Ekser

Goggins

Fridell

et al. 2020

Transplantation Direct

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Background. Elderly recipients (≥70 y) account for 2.6% of all liver transplants (LTs) in the United States and have similar outcomes as younger recipients. Although the rate of elderly recipients in combined liver-kidney transplant (CLKT) is similar, limited data are available on how elderly recipients perform after CLKT. Methods. We have previously shown excellent outcomes in CLKT using delayed kidney transplant (Indiana) Approach (mean kidney cold ischemia time = 53 ± 14 h). Between 2007 and 2018, 98 CLKTs were performed using the Indiana Approach at Indiana University (IU) and the data were retrospectively analyzed. Recipients were subgrouped based on their age: 18–45 (n = 16), 46–59 (n = 34), 60–69 (n = 40), and ≥70 years (n = 8). Results. Overall, more elderly patients received LT at IU (5.2%) when compared nationally (2.6%). The rate of elderly recipients in CLKT at IU was 8.2% (versus 2% Scientific Registry of Transplant Recipient). Recipient and donor characteristics were comparable between all age groups except recipient age and duration of dialysis. Patient survival at 1 and 3 years was similar among younger age groups, whereas patient survival was significantly lower in elderly recipients at 1 (60%) and 3 years (40%) ( P = 0.0077). Control analyses (replicating Scientific Registry of Transplant Recipient’s survival stratification: 18–45, 46–64, ≥65 y) showed similar patient survival in all age groups. Conclusions. Although LT can be safely performed in elderly recipients, extreme caution is needed in CLKT due to the magnitude of operation.

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“…Several additional studies have suggested that older patients have comparable survival rates with younger cohorts, but these studies have significant limitations . Because UNOS measures center performance as a metric of accountability and because risk is not age adjusted, patients of advanced age transplanted in the current U.S. allocation system are highly selective.…”

Section: Rebuttal To the “Pro” Argumentmentioning

confidence: 99%

“…Kollman et al in a single‐center study compared 76 patients aged 65 years or older who received LT with 1395 patients younger than 65 years, and suggested comparable 1‐ and 5‐year survival rates for the two age groups. However, LT recipients in the “elderly” group had an average physiological MELD at transplant of 17, and more than half received an organ from a donor younger than 50 years old—practices that are not representative of most centers in the United States.…”

Section: Rebuttal To the “Pro” Argumentmentioning

confidence: 99%

CON: Patients of Advanced Age Should Not Routinely Undergo Liver Transplantation

Kalra

Kriss

Francis

et al. 2019

Clinical Liver Disease

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Careful patient selection forms the foundation for improving patient outcomes after liver transplantation (LT). This also provides inherent selection bias in studies suggesting comparable post-LT outcomes in patients with advanced age compared with younger cohorts. • Despite this, studies from the United States, Europe, and Asia have demonstrated higher mortality in transplant recipients of advanced age. • Older transplant recipients in the United States are more likely to receive grafts from older donors. The use of organs from older donors (>60 years old) is associated with worse 5-year graft outcomes and increased 5-year mortality, further compounding the increased mortality in transplant recipients of advanced age. • Studies supporting the "pro" argument have significant limitations that preclude generalizability for most transplant centers.In the United States, the number of individuals older than 75 years is projected to double to more than 10% of the population by the year 2050, 1 and the question of whether to transplant patients of advanced age has thus become increasingly relevant. In practice, however, this is not a question of whether these patients deserve transplantation any more or less than younger patients. Nor is it a question of whether the transplant community is capable of successfully transplanting and caring for such a patient.After all, in the modern era of LT, overall 5-year graft and patient survival are each greater than 70% and continue to improve. 2 Although this is a testament to high-quality medical and surgical care of transplant registrants and recipients, the foundation for these outcomes is responsible allocation of donor organs via careful patient selection for transplantation. In that context, patients of advanced age (>70 years) should not routinely be considered appropriate candidates for LT.

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Outcome after liver transplantation in elderly recipients (>65 years) — A single-center retrospective analysis

Cited by 11 publications

References 48 publications

Living Donor Liver Transplant in Patients Aged 60 Years or Older: Experience from a Large Volume Centre in India

Living Donor Liver Transplant in Patients Aged 60 Years or Older: Experience from a Large Volume Centre in India

Impact of Recipient Age in Combined Liver-Kidney Transplantation: Caution Is Needed for Patients ≥70 Years

CON: Patients of Advanced Age Should Not Routinely Undergo Liver Transplantation

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