Liver transplantation in elderly patients: a systematic review and first meta-analysis

Gavara, Concepcion Gomez; Esposito, Francesco; Gurusamy, Kurinchi Selvan; Salloum, Chady; Lahat, Eylon; Féray, Cyrille; Lim, Chetana; Azoulay, Daniel

doi:10.1016/j.hpb.2018.07.025

Cited by 36 publications

(28 citation statements)

References 60 publications

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“…Although our results are encouraging for elderly patients with end‐stage liver diseases, we continue to use caution in identifying candidates who would derive the most benefit from transplant . With advances in medicine and science, age is no longer the dominant factor as an independent or absolute criterion of eligibility for LT . However, each transplant center may approach the elderly population individually on the basis of their surgical, medical, and integrative capacity.…”

Section: Discussionmentioning

confidence: 94%

Evolving Role of Liver Transplantation in Elderly Recipients

Mousa¹,

Nguyen²,

Ma³

et al. 2019

Liver Transpl

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The need for liver transplantation (LT) among older patients is increasing, but the role of LT in the elderly (≥70 years) is not well defined. We retrospectively reviewed all primary LTs from 1998 through 2016 at our center. Survival and associated risk factors were analyzed with Cox regression and Kaplan‐Meier methods for LT recipients in 3 age groups: <60, 60‐69, and ≥70 years. Among 2281 LT recipients, the median age was 56 years (range, 15‐80 years), and 162 were aged ≥70 years. The estimated 5‐ and 10‐year patient survival probabilities for elderly LT recipients were lower (70.8% and 43.6%) than for recipients aged 60‐69 years (77.2% and 64.6%) and <60 years (80.7% and 67.6%). Patient and graft survival rates associated with LT improved over time from the pre–Model for End‐Stage Liver Disease era to Share 15, pre–Share 35, and Share 35 for the cohort overall (P < 0.001), but rates remained relatively stable in septuagenarians throughout the study periods (all P > 0.45). There was no incremental negative effect of age at LT among elderly patients aged 70‐75 years (log‐rank P = 0.32). Among elderly LT recipients, greater requirement for packed red blood cells and longer warm ischemia times were significantly associated with decreased survival (P < 0.05). Survival of LT recipients, regardless of age, markedly surpassed that of patients who were denied LT, but it was persistently 20%‐30% lower than the expected survival of the general US population (P < 0.001). With the aging of the population, select older patients with end‐stage liver diseases can benefit from LT, which largely restores their expected life spans.

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Section: Discussionmentioning

confidence: 94%

Evolving Role of Liver Transplantation in Elderly Recipients

Mousa¹,

Nguyen²,

Ma³

et al. 2019

Liver Transpl

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“…35,47 With strict selection, the outcomes of elderly liver recipients is already similar to younger patients. 35,48,49 Despite current reluctance, the increasingly advanced methods to determine physiological condition as well as these promising LT results might be a reason for more liberal interpretation of calendar age criteria in the future. In order to be included in the Mayo Clinic cohort, no definite pathological confirmation was required.…”

Section: Discussionmentioning

confidence: 99%

Eligibility for liver transplantation in patients with perihilar cholangiocarcinoma

Vugts

Gaspersz

Roos

et al. 2020

European Journal of Surgical Oncology

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Background. Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. Methods. Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. Results. A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3-23). Conclusion. Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed. Perihilar cholangiocarcinoma (pCCA) is the most common malignancy of the biliary tract and arises from biliary epithelial cells at the liver hilum. 1,2 The annual incidence in Western countries is about 1-2 per 100,000. 3 The standard curative option for patients with pCCA is a radical surgical resection which is associated with a median overall survival (OS) of 40 months after resection and a 5-year survival of 30-50%. 4,5 The majority of patients with pCCA ([ 80%), however, are considered unresectable at the time of presentation. 6,7 The median survival of patients with unresectable disease is only 6 months, which can be prolonged to a median of 12 months by palliative chemotherapy including gemcitabine and cisplatinum. 6-8 Bas Groot Koerkamp and Stefan Buettner have contributed equally to this work.

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“…A small, retrospective analysis of outcomes in recipients older than 75 years showed a mean survival of 65 months after LT . Finally, a recent meta‐analysis of pooled data from LTs done in 23,660 older adults between 2000 and 2018 concluded that there is no significant difference in patient and graft survival between older and younger recipients . Taken together, the evidence suggests that patient and graft survival in carefully selected older adults are comparable with younger counterparts.…”

Section: Posttransplant Outcomes In Older Adults Are Robustmentioning

confidence: 99%

PRO: Older Adults Should Be Offered Liver Transplantation

Haque

Palumbo

Batisti

2019

Clinical Liver Disease

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Decisions regarding transplant candidacy should be individualized. If an older adult is predicted to derive a survival benefit from liver transplantation (LT) and there is no other contraindication, then his or her candidacy should be considered. • Posttransplant survival rates for carefully selected recipients older than 70 years are comparable with younger counterparts at up to 10 years of follow-up. • Physiological age characterized by functional status, presence of comorbidities, frailty, and sarcopenia is a more accurate determinant of posttransplant outcomes than chronological age and should carry more significance when determining transplant candidacy. • Appropriately selected older adults can be offered transplantation through living donation.LT is the only definitive therapy for end-stage liver disease. 1 Successful LT improves life expectancy and quality of life in patients with decompensated cirrhosis, including older adults without additional significant comorbidities. 1 There are currently more than 49 million adults older than 65 years in the United States, and this number will continue to increase so much so that older adults are expected to outnumber children by the year 2035. 2 The burden of liver disease in the elderly is also expanding, and with it the number of patients older than 65 years who are listed for LT. 3 With these changing demographics, considering LT for older candidates is an inevitable reality. For those with no contraindications and otherwise unremarkable LT evaluations including a normal cardiopulmonary assessment, good social support, and robust functional status, LT is a reasonable option. OlDer aDUlTs Can Derive a siGniFiCanT sUrvival BeneFiT FrOM liver TransPlanTaTiOnThe median survival for patients with decompensated cirrhosis is approximately 2 years. 4 As the number of Abbreviations: 6MWD, 6-minute walk distance; LT, liver transplantation; MELD, Model for End-Stage Liver Disease.

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Liver transplantation in elderly patients: a systematic review and first meta-analysis

Abstract: Elderly patients have similar long-term survival and graft loss rates as young patients. Liver transplantation is an acceptable and safe curative option for elderly transplant candidates.

Cited by 36 publications

References 60 publications

Evolving Role of Liver Transplantation in Elderly Recipients

Evolving Role of Liver Transplantation in Elderly Recipients

Eligibility for liver transplantation in patients with perihilar cholangiocarcinoma

PRO: Older Adults Should Be Offered Liver Transplantation

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