BOSTON — Carefully selected liver transplant recipients older than 70 years can have survival rates similar to those of patients in their 50s, Dr. Gerald S. Lipshutz reported at the 2006 World Transplant Congress.
“As the older population continues to grow, more transplant centers will be forced to consider liver transplantation in the elderly,” said Dr. Lipshutz of the University of California, Los Angeles.
Previous single-center studies of liver transplant recipients aged 60 years and older have reported 5-year survival rates of 52%–69%. Kaplan-Meier curve estimates have predicted 10-year survival to be about 35% in that population. But no studies so far have looked at the outcomes of septuagenarians after liver transplant, Dr. Lipshutz said.
Dr. Lipshutz compared the outcome of liver transplants performed at his center during 1988–2005 in recipients aged 70–79 years with transplants in those aged 50–59 years. The 62 liver transplant recipients in the older group had a mean age of 72 years while the 864 younger patients had an average age of 54 years.
To be put on the liver transplant wait list, patients had to undergo “aggressive cardiac clearance.” If there was any evidence of significant cardiovascular disease, they had to undergo coronary artery catheterization.
Survival rates at 1, 3, 5, and 10 years were higher in the younger group than in the older group, but the difference was never statistically significant. At 1 year, survival rates were about 79% and 73%, respectively, followed by 72% and 66% at 3 years, 65% and 49% at 5 years, and 54% and 40% at 10 years.
A multivariate analysis combining both groups of patients showed that significant risk factors for death were preoperative hospitalization, longer cold ischemia times of the donor liver, a liver disease etiology of hepatitis C virus infection, and alcohol consumption. An age of 70 years or older was not a significant risk factor.
“With appropriate selection and screening, transplants in select septuagenarians may result in long-term survival,” Dr. Lipshutz said at the congress, which was sponsored by the American Society of Transplant Surgeons, the American Society of Transplantation, and the Transplantation Society.