Liver transplantation in recipients over 65 yr old: a single center experience

Audet, Maxime; Piardi, Tullio; Panaro, Fabrizio; Cağ, Murat; Ghislotti, E.; Habibeh, Hussein; Giulini, Stefano Maria; Jaeck, Daniel; Wolf, Philippe

doi:10.1111/j.1399-0012.2009.00972.x

Cited by 26 publications

(27 citation statements)

References 43 publications

(50 reference statements)

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“…As a result of the increasing average age at which patients are now undergoing transplantation, prevalent CVD comorbidity at the time of transplantation is expected to rise with adverse effects on posttransplant outcomes . Age remained a significant predictor in our multivariate model, and this again highlights concerns about the increased cardiac risk associated with the aging transplant recipient population.…”

Section: Discussionmentioning

confidence: 84%

High early cardiovascular mortality after liver transplantation

et al. 2014

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Cardiovascular disease (CVD) contributes to excess long-term mortality after liver transplantation (LT), however little is known about early post-operative CVD mortality in the current era. In addition, there is no model to predict early post-operative CVD mortality across centers. We analyzed adult recipients of primary LT in the Organ Procurement and Transplantation Network (OPTN) database between February 2002 and December 2012 to assess prevalence and predictors of early (30-day) CVD mortality, defined as death from arrhythmia, heart failure, myocardial infarction, cardiac arrest, thromboembolism, and/or stroke. We performed logistic regression with stepwise selection to develop a predictive model of early CVD mortality. Sex and center volume were forced into the final model, which was validated using bootstrapping techniques. Among 54,697 LT recipients, there were 1576 (2.9%) deaths within 30 days. CVD death was the leading cause of 30-day mortality (42.1%), followed by infection (27.9%) and graft failure (12.2%). In multivariate analysis, 9 (6 recipient, 2 donor, 1 operative) significant covariates were identified: age, pre-operative hospitalization, ICU and ventilator status, calculated MELD score, portal vein thrombosis, national organ sharing, donor BMI and cold ischemia time. The model showed moderate discrimination (c-statistic 0.66, 95% CI: 0.63–0.68). We provide the first multicenter prognostic model for the prediction of early post-LT CVD death, the most common cause of early post-LT mortality in the current transplant era. However, evaluation of additional CVD-related variables not collected by the OPTN are needed in order to improve model accuracy and potential clinical utility.

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Section: Discussionmentioning

confidence: 84%

High early cardiovascular mortality after liver transplantation

et al. 2014

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“…The high prevalence of CVD-related morbidity and mortality is likely a result of several factors affecting LT candidates. The aging LT population is increasingly affected by significant medical comorbidities(4) that may result in adverse post-transplant outcomes(5, 6). Second, with increased prioritization of the sickest LT candidates for transplant, there is a growing critical illness burden among those with high model-for-end-stage-liver-disease (MELD) scores and an increased proportion of ventilator-dependent patients at the time of transplant(7).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

VanWagner

Serper

Kang

et al. 2016

American Journal of Transplantation

151

161

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Assessment of major adverse cardiovascular events (MACE) after liver transplantation (LT) has been limited by the lack of a multi-center study with detailed clinical information. An integrated database linking information from the University HealthSystem Consortium and the OPTN was analyzed using multivariate Poisson regression to assess factors associated with 30- and 90-day MACE after LT (2/2002–12/2012). MACE were defined as myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), cardiac arrest, pulmonary embolism and/or stroke. Of 32,810 recipients, MACE hospitalizations occurred in 8% and 11% of patients at 30 and 90 days. Recipients with MACE were older, and more likely to have a history of NASH, alcoholic cirrhosis (ETOH), MI, HF, stroke, AF and pulmonary and chronic renal disease than those without MACE. In multivariable analysis, age > 65 (Incidence rate ratio (IRR)=2.8 (1.8–4.4)), ETOH (IRR=1.6 (1.2–2.2)), NASH (IRR=1.6 (1.1–2.4)), pre-LT creatinine (IRR=1.1 (1.04–1.2)), baseline AF (IRR=6.9 (5.0–9.6)) and stroke (IRR=6.3 (1.6–25.4)) were independently associated with MACE. MACE were associated with lower 1-year survival post-LT (79% vs. 88%, p<.0001). In a national database, MACE occurred in 11% of LT recipients with a negative impact on survival. Pre-LT AF and stroke substantially increase risk of MACE, highlighting potentially high-risk LT candidates.

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“…In Western and Southern Europe, a limited number of potential deceased donors have resulted in an increased number of recipients on waiting lists for liver transplantation. This has led to graft acceptance from older and "marginal" donors [2]. In many liver transplantation departments, nonstandard liver donors (>60 years old) comprise almost one half of the total number of cadaveric donors [3,4].…”

Section: Discussionmentioning

confidence: 99%