Evolving Role of Liver Transplantation in Elderly Recipients

Omar Y. Mousa, Justin H Nguyen, Yaohua Ma, Bhupendra Rawal, Kaitlyn R. Musto, Marjorie K. Dougherty, Jefree A. Shalev, Denise Harnois

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1363-1374
Number of pages12
JournalLiver Transplantation
Volume25
Issue number9
DOIs
StatePublished - Jan 1 2019

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Liver Transplantation
Survival
Warm Ischemia
End Stage Liver Disease
Population
Age Groups
Erythrocytes

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Evolving Role of Liver Transplantation in Elderly Recipients. / Mousa, Omar Y.; Nguyen, Justin H; Ma, Yaohua; Rawal, Bhupendra; Musto, Kaitlyn R.; Dougherty, Marjorie K.; Shalev, Jefree A.; Harnois, Denise.

In: Liver Transplantation, Vol. 25, No. 9, 01.01.2019, p. 1363-1374.

Research output: Contribution to journalArticle

Mousa, OY, Nguyen, JH, Ma, Y, Rawal, B, Musto, KR, Dougherty, MK, Shalev, JA & Harnois, D 2019, 'Evolving Role of Liver Transplantation in Elderly Recipients', Liver Transplantation, vol. 25, no. 9, pp. 1363-1374. https://doi.org/10.1002/lt.25589
Mousa OY, Nguyen JH, Ma Y, Rawal B, Musto KR, Dougherty MK et al. Evolving Role of Liver Transplantation in Elderly Recipients. Liver Transplantation. 2019 Jan 1;25(9):1363-1374. https://doi.org/10.1002/lt.25589
Mousa, Omar Y. ; Nguyen, Justin H ; Ma, Yaohua ; Rawal, Bhupendra ; Musto, Kaitlyn R. ; Dougherty, Marjorie K. ; Shalev, Jefree A. ; Harnois, Denise. / Evolving Role of Liver Transplantation in Elderly Recipients. In: Liver Transplantation. 2019 ; Vol. 25, No. 9. pp. 1363-1374.
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