Liver transplantation in elderly patients: what do we know at the beginning of 2020?

Abstract

An aging population has prompted us to evaluate the indications of liver transplantation (LT) in elderly patients more frequently. In this review, we summarize the short-and long-term results after LT in elderly patients and also discuss the criteria used to select patients and how recipient age can challenge current allocation systems. Briefly, the feasibility and early outcomes of LT in elderly patients compare favorably with those of younger patients. Although long-term survival is less than satisfactory, large-scale studies show that the transplant survival benefit is similar for elderly and younger patients. Therefore, age alone does not contraindicate LT; however, screening for cardiopulmonary comorbidities, and asymptomatic malignancies, evaluating nutritional status, and frailty, is crucial to ensure optimal results and avoid futile transplantation.

Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

“…Although the panel does not have a recommendation regarding liver transplantation in older adults with HCC, some centers report transplant in highly selected patients older than 70 years. [114][115][116][117] Bridge Therapy Bridge therapy is used to decrease tumor progression and the dropout rate from the liver transplantation waiting list. 118 It is considered for patients who meet the transplant criteria.…”

Hepatocellular cancer and colorectal liver metastasis treatment in the older population

“…Data from the United Network for Organ Sharing and the European Liver Transplant Registry show a significant increase in the number of patients over 70 years with end-stage liver disease who qualified for a liver transplant in the last decade; it was also one of the fastest-growing patient populations [32]. In the 2019 systematic review and meta-analysis, Gavara et al did observe acceptable short-and long-term results.…”

“…They also did not find any difference in the risk of complications between young and older patients [33]. Although long-term liver transplant results are very good, older patients are rarely qualified because of their low priority on the list of available organs [32,33].…”

Preoperative evaluation of geriatric patients undergoing liver transplantation

“…Some studies suggest that outcome of elderly patients receiving LT are comparable to younger patients, whereas other suggest that that median survival in elderly patients is lower than younger age group (18-59 years) [13][14][15]. Several scoring systems have been proposed for predicting longterm outcomes after LT.…”