The elderly liver transplant recipient

A call for caution

Marlon F. Levy, Ponnandai S. Somasundar, Linda W. Jennings, Ghap J. Jung, Ernesto P. Molmenti, Carlos G. Fasola, Robert M. Goldstein, Thomas A. Gonwa, Goran B. Klintmalm

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Objective: To determine whether liver transplantation is judicious in recipients older than 60 years of age. Summary Background Data: The prevailing opinion among the transplant community remains that elderly recipients of liver allografts fare as well as their younger counterparts, but our results have in some cases been disappointing. This study was undertaken to review the results of liver transplants in the elderly in a large single-center setting. A secondary goal was to define, if possible, factors that could help the clinician in the prudent allocation of the donor liver. Methods: A retrospective review of a prospectively maintained single-institution database of 1,446 consecutive liver transplant recipients was conducted. The 241 elderly patients (older than 60 years) were compared with their younger counterparts by preoperative laboratory values, illness severity, nutritional status, and donor age. Survival data were stratified and logistic regression analyses were conducted. Results: Elderly patients with better-preserved hepatic synthetic function or with lower pretransplant serum bilirubin levels fared as well as younger patients. Elderly patients who had poor hepatic synthetic function or high bilirubin levels or who were admitted to the hospital had much lower survival rates than the sicker younger patients or the less-ill older patients. Recipient age 60 years or older, pretransplant hospital admission, and high bilirubin level were independent risk factors for poorer outcome. Conclusions: Low-risk elderly patients fare as well as younger patients after liver transplantation. However, unless results can be improved, high-risk patients older than 60 years should probably not undergo liver transplantation.

Original languageEnglish (US)
Pages (from-to)107-113
Number of pages7
JournalAnnals of Surgery
Volume233
Issue number1
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Liver
Bilirubin
Liver Transplantation
Tissue Donors
Transplants
Transplant Recipients
Nutritional Status
Allografts
Survival Rate
Logistic Models
Regression Analysis
Databases
Survival
Serum

ASJC Scopus subject areas

  • Surgery

Cite this

Levy, M. F., Somasundar, P. S., Jennings, L. W., Jung, G. J., Molmenti, E. P., Fasola, C. G., ... Klintmalm, G. B. (2001). The elderly liver transplant recipient: A call for caution. Annals of Surgery, 233(1), 107-113. https://doi.org/10.1097/00000658-200101000-00016

The elderly liver transplant recipient : A call for caution. / Levy, Marlon F.; Somasundar, Ponnandai S.; Jennings, Linda W.; Jung, Ghap J.; Molmenti, Ernesto P.; Fasola, Carlos G.; Goldstein, Robert M.; Gonwa, Thomas A.; Klintmalm, Goran B.

In: Annals of Surgery, Vol. 233, No. 1, 2001, p. 107-113.

Research output: Contribution to journalArticle

Levy, MF, Somasundar, PS, Jennings, LW, Jung, GJ, Molmenti, EP, Fasola, CG, Goldstein, RM, Gonwa, TA & Klintmalm, GB 2001, 'The elderly liver transplant recipient: A call for caution', Annals of Surgery, vol. 233, no. 1, pp. 107-113. https://doi.org/10.1097/00000658-200101000-00016
Levy MF, Somasundar PS, Jennings LW, Jung GJ, Molmenti EP, Fasola CG et al. The elderly liver transplant recipient: A call for caution. Annals of Surgery. 2001;233(1):107-113. https://doi.org/10.1097/00000658-200101000-00016
Levy, Marlon F. ; Somasundar, Ponnandai S. ; Jennings, Linda W. ; Jung, Ghap J. ; Molmenti, Ernesto P. ; Fasola, Carlos G. ; Goldstein, Robert M. ; Gonwa, Thomas A. ; Klintmalm, Goran B. / The elderly liver transplant recipient : A call for caution. In: Annals of Surgery. 2001 ; Vol. 233, No. 1. pp. 107-113.
@article{86029560d3c1457097dbeba3204a9d9c,
title = "The elderly liver transplant recipient: A call for caution",
abstract = "Objective: To determine whether liver transplantation is judicious in recipients older than 60 years of age. Summary Background Data: The prevailing opinion among the transplant community remains that elderly recipients of liver allografts fare as well as their younger counterparts, but our results have in some cases been disappointing. This study was undertaken to review the results of liver transplants in the elderly in a large single-center setting. A secondary goal was to define, if possible, factors that could help the clinician in the prudent allocation of the donor liver. Methods: A retrospective review of a prospectively maintained single-institution database of 1,446 consecutive liver transplant recipients was conducted. The 241 elderly patients (older than 60 years) were compared with their younger counterparts by preoperative laboratory values, illness severity, nutritional status, and donor age. Survival data were stratified and logistic regression analyses were conducted. Results: Elderly patients with better-preserved hepatic synthetic function or with lower pretransplant serum bilirubin levels fared as well as younger patients. Elderly patients who had poor hepatic synthetic function or high bilirubin levels or who were admitted to the hospital had much lower survival rates than the sicker younger patients or the less-ill older patients. Recipient age 60 years or older, pretransplant hospital admission, and high bilirubin level were independent risk factors for poorer outcome. Conclusions: Low-risk elderly patients fare as well as younger patients after liver transplantation. However, unless results can be improved, high-risk patients older than 60 years should probably not undergo liver transplantation.",
author = "Levy, {Marlon F.} and Somasundar, {Ponnandai S.} and Jennings, {Linda W.} and Jung, {Ghap J.} and Molmenti, {Ernesto P.} and Fasola, {Carlos G.} and Goldstein, {Robert M.} and Gonwa, {Thomas A.} and Klintmalm, {Goran B.}",
year = "2001",
doi = "10.1097/00000658-200101000-00016",
language = "English (US)",
volume = "233",
pages = "107--113",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - The elderly liver transplant recipient

T2 - A call for caution

AU - Levy, Marlon F.

AU - Somasundar, Ponnandai S.

AU - Jennings, Linda W.

AU - Jung, Ghap J.

AU - Molmenti, Ernesto P.

AU - Fasola, Carlos G.

AU - Goldstein, Robert M.

AU - Gonwa, Thomas A.

AU - Klintmalm, Goran B.

PY - 2001

Y1 - 2001

N2 - Objective: To determine whether liver transplantation is judicious in recipients older than 60 years of age. Summary Background Data: The prevailing opinion among the transplant community remains that elderly recipients of liver allografts fare as well as their younger counterparts, but our results have in some cases been disappointing. This study was undertaken to review the results of liver transplants in the elderly in a large single-center setting. A secondary goal was to define, if possible, factors that could help the clinician in the prudent allocation of the donor liver. Methods: A retrospective review of a prospectively maintained single-institution database of 1,446 consecutive liver transplant recipients was conducted. The 241 elderly patients (older than 60 years) were compared with their younger counterparts by preoperative laboratory values, illness severity, nutritional status, and donor age. Survival data were stratified and logistic regression analyses were conducted. Results: Elderly patients with better-preserved hepatic synthetic function or with lower pretransplant serum bilirubin levels fared as well as younger patients. Elderly patients who had poor hepatic synthetic function or high bilirubin levels or who were admitted to the hospital had much lower survival rates than the sicker younger patients or the less-ill older patients. Recipient age 60 years or older, pretransplant hospital admission, and high bilirubin level were independent risk factors for poorer outcome. Conclusions: Low-risk elderly patients fare as well as younger patients after liver transplantation. However, unless results can be improved, high-risk patients older than 60 years should probably not undergo liver transplantation.

AB - Objective: To determine whether liver transplantation is judicious in recipients older than 60 years of age. Summary Background Data: The prevailing opinion among the transplant community remains that elderly recipients of liver allografts fare as well as their younger counterparts, but our results have in some cases been disappointing. This study was undertaken to review the results of liver transplants in the elderly in a large single-center setting. A secondary goal was to define, if possible, factors that could help the clinician in the prudent allocation of the donor liver. Methods: A retrospective review of a prospectively maintained single-institution database of 1,446 consecutive liver transplant recipients was conducted. The 241 elderly patients (older than 60 years) were compared with their younger counterparts by preoperative laboratory values, illness severity, nutritional status, and donor age. Survival data were stratified and logistic regression analyses were conducted. Results: Elderly patients with better-preserved hepatic synthetic function or with lower pretransplant serum bilirubin levels fared as well as younger patients. Elderly patients who had poor hepatic synthetic function or high bilirubin levels or who were admitted to the hospital had much lower survival rates than the sicker younger patients or the less-ill older patients. Recipient age 60 years or older, pretransplant hospital admission, and high bilirubin level were independent risk factors for poorer outcome. Conclusions: Low-risk elderly patients fare as well as younger patients after liver transplantation. However, unless results can be improved, high-risk patients older than 60 years should probably not undergo liver transplantation.

UR - http://www.scopus.com/inward/record.url?scp=0035161143&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035161143&partnerID=8YFLogxK

U2 - 10.1097/00000658-200101000-00016

DO - 10.1097/00000658-200101000-00016

M3 - Article

VL - 233

SP - 107

EP - 113

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 1

ER -