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

Abstract

With increased demand for liver transplantation (LT), outcomes of older recipients have been subjected to greater scrutiny, as previous studies have demonstrated poorer survival outcomes. Outcomes of 77 patients aged Ͼ 65 yr (group 1) who underwent transplantation between 1988 and 2003 at King's College Hospital, London, were compared with all recipients aged between 60 and 64 yr (group 2, n ϭ 137) and 202 time-matched control patients with chronic liver disease aged between 18-59 yr (group 3). Patient survival at 30-days for groups 1, 2, and 3 were 99%, 94%, and 94%, respectively (P ϭ not significant [NS]). At 1-yr, survival in the 3 groups was 82%, 86%, and 83%, respectively (P ϭ NS), and at 5-yr patient survival was comparable (73%, 80%, and 78%, respectively) (P ϭ NS). Episodes of acute cellular rejection (ACR) were fewer in the older cohorts (43% vs. 45% vs. 61%, P ϭ 0.0016), although there was no significant difference identified in the numbers of patients in each group who experienced ACR (P ϭ 0.16). A similar but nonsignificant trend was identified for rates of chronic rejection among the groups. In conclusion, these data suggest that survival of patients over 60 and 65 yr undergoing LT is satisfactory, at least in the first 5-yr posttransplantation. In addition, patients over 65 yr experience less rejection, with good graft survival. Thus, LT should not be denied to patients Ͼ65 yr on the basis of age alone, once a comprehensive screen for comorbidity has been undertaken.

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

“…Similar results after OLT have been reported for elderly patients as for younger recipients (Pirsch et al 1991;Zettermann et al 1998). Short-term survival rates after OLT for seniors are comparable to those of younger adults (Levy et al 2001;Garcia et al 2001), whereas long-term survival rates are considered to be lower as compared to younger recipients due to complications like malignancies or heart diseases (Cross et al 2007). Considering these, improving long-and short-term results in the elderly recipient population additional factors like the recipient quality of life after OLT have to be taken into account.…”

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“…7 The humoral defect is thought to be the result of an exaggerated anti-idiotype antibody response to antigens that down-regulates the antibody response to those antigens, thus inhibiting the humoral response. 8,9 Depending on this defective immunity, it might be expected that a lower incidence of acute rejection and higher rate of opportunistic infections may occur in elderly liver transplant patients. The most common cause of fatal infection in older patients was fungal sepsis.…”

Elderly Living Donor Liver Transplant Recipients Over 60 Years Old at a Japanese Single Center

“…However, the optimal living donor liver transplantation (LDLT) indication, with regard to age, is still controversial [1,2]. LDLT has been shown to be inferior to total liver transplantation from cadaveric donor [1,2]. Insufficient immune activity of partial liver often results in critical infectious diseases that become life threatening, especially in elderly patients, who sometimes have latent infectious disease.…”

“…However, the optimal living donor liver transplantation (LDLT) indication, with regard to age, is still controversial [1,2]. LDLT has been shown to be inferior to total liver transplantation from cadaveric donor [1,2].…”