Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

Abstract

Older age is not considered a contraindication for liver transplantation, but age-related morbidity may be a cause of mortality. Survival and the incidence of the main post-transplant complications were assessed in 111 adult liver transplant recipients. They were divided in two groups according to their age (patients younger than 60 years, n = = 54; patients older than 60 years, n = = 57) and both groups were compared. Older patients were more frequently transplanted for hepatitis C (p = = 0.03) and hepatocellular carcinoma (p = = 0.05) and their liver disease was less advanced (Child-Pugh and MELD scores were significantly lower; p = = 0.004 and p = = 0.05, respectively). After transplantation, older patients had a significantly lower survival (p = = 0.02). Higher age was independently associated with mortality (hazard ratio for each 10-year increase: 2.1; 95% confidence interval: 1.1-4.0; p = = 0.02). The incidence of de novo neoplasia and nonskin neoplasia were higher in older patients (p = = 0.02 and p = = 0.007, respectively). Malignancy was the cause of death in one patient younger than 60 years and in 12 patients older than 60 years (p = = 0.002). In multivariate analysis, a higher age and smoking were independently associated with a higher risk of dying of de novo neoplasia. In conclusion, older liver transplant recipients have a significantly lower survival than younger patients. Malignancy is responsible for this decreased survival.

Long-term quality of life of liver transplant recipients beyond 60 years of age

“…Although studies were able to show that patients have a different attitude towards solid organ donation, routine assessments and a psychological follow-up of transplanted patients are still missing widely especially in geriatric patient populations (Stadlbauer et al 2011;Herrero et al 2003;Solá et al 2012).…”

Liver transplantation in patients over 60 and 65 years: An evaluation of long-term outcomes and survival

“…4 The etiology of cirrhosis differs between different age groups, with the median age for diagnosis of primary biliary cirrhosis in previous studies being 60 yr. 5,6 Alcohol-related liver-disease is more prevalent in older patients, with as many as 28% of first presentations of alcohol-related liver-disease occurring in patients aged over 60 yr, 7 while age is increasingly recognized as an important variable in hepatocellular carcinoma. 8 Despite many apparent disadvantages of old age visa-vis transplantation, 9,10 a potential advantage may be that of immune senescence. This is characterized by a diminished responsiveness of the immune system, and it has been postulated that this declining immune responsiveness may be associated with reduced episodes and severity of graft rejection, as many centers have reported less episodes of acute cellular rejection (ACR) in older patients.…”

Recent Trends in Computational Prediction of Renal Transplantation Outcomes

“…The study clearly showed that for a patient who is younger in age, had few HLA mismatch , low PRA level and had no previous history of transplantation had more life span compared to others. Herrero et al [10] conducted the study on liver transplant candidates, they compared between two groups (younger and older). The study showed that the patients belonging to the younger group have a greater lifespan after the transplantation.…”