Our experience in liver transplantation in patients over 65 yr of age

Bilbao, Itxarone; Dopazo, Cristina; Lázaro, José; Castells, Lluı́s; Escartín, Alfredo; López, Iñigo; Sapisochín, Gonzalo; Balsells, J.; Margarit, C

doi:10.1111/j.1399-0012.2007.00749.x

Cited by 48 publications

(58 citation statements)

References 24 publications

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“…The cause was hepatitis B in 180 (43%), cryptogenic in 66 (16%), hepatitis C in 64 (14%), alcoholic in 58 (14%), non-alcoholic stereohepatitis in 34 (8%), and primary bilary cirrhosis or primary sclerosing cholangitis in 22 patients (5%). The median MELD score was 16 (IQR, [12][13][14][15][16][17][18][19][20]. All patients received the right lobe of their donor in a standard technique.…”

Section: Resultsmentioning

confidence: 99%

“…All of the patients had at least one complication of their liver cirrhosis, such as hepatic encephalopathy, variceal bleeding, or spontaneous bacterial peritonitis. The median model for end-stage liver disease (MELD) score was 13 (interquartile range [IQR], [11][12][13][14][15][16][17] and the median World Health Organization (WHO) performance status was preoperatively three (IQR, 3-3.5). The measured median skeletal muscle area, using preoperative computed tomography scan, was 98 cm 2 (IQR, 95-125) in men and 68 cm 2 (IQR, 61-87) in women.…”

Section: Resultsmentioning

confidence: 99%

“…The age limit of the recipient is one of the commonly discussed topics. [13][14][15][16] There is one publication about recipients older than 60 years, who underwent LDLT, which describes prolonged hospital stay in elderly patients compared to the younger group. There is no significant difference regarding the postoperative complications and 5-year survival.…”

Section: Discussionmentioning

confidence: 99%

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Living Donor Liver Transplantation in Patients 70 Years or Older

et al. 2015

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Living Donor Liver Transplantation in Patients 70 Years or Older

et al. 2015

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“…Three recent studies are especially noteworthy: all demonstrated 5‐year survival rates greater than 70% and mortality rates comparable to those of younger populations 29, 30, 39. Many centers continue to view the transplant candidacy of 60‐ and 70‐year‐old patients with a great deal of scrutiny, however, because data contrary to these reports exist in abundance 13, 17, 23, 24, 32, 35, 40‐46. In fact, higher recipient age has been independently associated with increased mortality after transplantation, with an HR of 2.1 being ascribed to each 10‐year increase 22.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma: The national experience

et al. 2012

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Current liver allocation policy in the United States grants liver transplant candidates with stage T2 hepatocellular carcinoma (HCC) a priority Model for End-Stage Liver Disease (MELD) score of 22, regardless of age. Because advanced age may portend an increase in all-cause mortality after transplantation for any diagnosis, the aim of this study was to examine overall posttransplant survival in elderly patients with HCC versus younger cohorts. Based on Organ Procurement and Transplantation Network data, Kaplan-Meier 5-year survival rates were compared. Recipients undergoing primary liver transplantation were stratified into cohorts based on age (<70 or 70 years) and the receipt of MELD exception points for HCC. Log-rank and Wilcoxon tests were used for statistical comparisons. In 2009, 143 transplants were performed for patients who were 70 years old or older. Forty-two percent of these patients received a MELD exception for HCC. Regardless of the diagnosis, the overall survival rate was significantly attenuated for the septuagenarians versus the younger cohort. After 5 years of follow-up, this disparity exceeded 10% to 15% depending on the populations being compared. The 1-, 2-, 3-, 4-, and 5-year actuarial survival rates were 88.4%, 83.2%, 79.6%, 76.1%, and 72.7%, respectively, for the patients who were younger than 70 years and 81.1%, 73.8%, 67.1%, 61.9%, and 55.2%, respectively, for the patients who were 70 years old or older. Five-year survival was negatively affected for patients with HCC who were younger than 70 years; this disparity was not observed for patients with HCC who were 70 years old or older. In conclusion, although patients who are 70 years old or older compose a small fraction of transplant recipients in the United States, patients in this group undergoing transplantation for HCC form an even smaller subset. Overall, transplantation in this age group yields outcomes inferior to those for younger cohorts. However, unlike patients who are less than 70 years old and receive MELD exception points, overall liver transplant survival is not affected by HCC at an advanced age.

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“…The morbidity and mortality of OLT recipients increase with age, particularly among patients more than 60 years old 16, 17. The excess mortality is due largely to nonhepatic causes,16 with CAD a major contributor during the intraoperative, early postoperative, and later phases 18, 19.…”

Section: Cad In Esld Patients and Its Significance In Clinical Managementioning

confidence: 99%

Coronary artery disease in orthotopic liver transplantation: Pretransplant assessment and management

et al. 2010

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The prevalence of coronary artery disease in end-stage liver disease is only now being recognized. Liver transplant patients are a high risk subgroup for coronary artery disease, even if asymptomatic. Coronary artery disease is a predictor of poor outcomes; therefore, identification of those at risk must be a key clinical priority. However, risk assessment is particularly difficult as many of the available diagnostic tools have either proven to be unhelpful or remain to be validated. Risk factor profiling has been unable to identify those at risk and commonly underestimates risk. The high negative predictive value of Dobutamine stress echo, when target heart rates are achieved, allows it to be used to identify a low risk group. For all other patients, proceeding to invasive coronary angiography is often necessary, and the risks of the procedure can be reduced by a transradial approach. Pharmacological reduction of the consequences of coronary artery disease can be limited by the underlying liver disease. Revascularization pre-transplantation is recommended in international guidelines but has demonstrated little evidence of benefit. Surgical revascularization carries an increased risk in these patients and is commonly performed pre-transplantation, although combined liver and cardiac surgery has been described. Percutaneous coronary intervention is increasingly used with patients requiring anti-platelet medication for up to one year after intervention. We present a review of all these issues and the evidence for assessing and managing these high-risk patients. Liver Transpl 16:550-557,

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Our experience in liver transplantation in patients over 65 yr of age

Abstract: Results in patients >65 yr are comparable to those <65 yr if older LT candidates are carefully selected. Overimmunosuppression should be avoided in older candidates, as its effects could worsen the pre-existing diseases common in elderly patients.

Cited by 48 publications

References 24 publications

Living Donor Liver Transplantation in Patients 70 Years or Older

Living Donor Liver Transplantation in Patients 70 Years or Older

Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma: The national experience

Coronary artery disease in orthotopic liver transplantation: Pretransplant assessment and management

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