Age alone does not increase risk of death following liver transplant among selected septuagenarians

August 20, 2007

Advanced age alone does not appear to be associated with the risk of death following liver transplant, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

Life expectancy has increased in recent years, with individuals older than 70 representing a large and fast-growing segment of the general population, according to background information in the article. A healthy 70-year-old adult living in a developed country with a nutritious diet and good medical care can expect to live to age 80 or 90. "As longevity has increased, the burden of liver disease in patients of advancing age has also increased and is associated with a higher mortality than in younger adults," the authors write. "In the 1980s, the death rate from chronic liver disease was highest in patients 65 to 74 years of age. This has led to more older patients undergoing liver transplantation."

Gerald S. Lipshutz, M.D., M.S., and colleagues at the David Geffen School of Medicine at UCLA reviewed the records of patients who received their first liver transplant between 1988 and 2005. They compared 62 patients who were age 70 or older (average age 71.9) to 864 patients age age 50 to 59 (average age 54.3). Survival time was measured until death, the last known follow-up date or retransplantation.

Overall, 31 of 62 patients age 70 or older and 345 of 864 patients younger than 70 died during the study period. After one year, 73.3 percent of older patients and 79.4 percent of younger patients survived; after ten years, 39.7 percent of older patients and 45.2 percent of younger patients were still alive. "We found no statistically significant difference in survival in the first 10 years after transplantation for a group of 62 patients 70 years or older when compared with a younger cohort of 864 recipients aged 50 to 59 years with similar characteristics," the authors write. "The longest-surviving patient was 88 years old at 15 years after transplantation. One-year unadjusted survival of septuagenarians in the most recent surgical period, 2001 to 2005, was 94.4 percent."

The researchers also analyzed 26 variables related to the recipients, donors and transplant operations to see which predicted patient deaths. Of the 26, four were associated with death rates: preoperative hospitalization, prolonged period of cold storage between liver removal and transplantation, cirrhosis caused by hepatitis C and alcohol and an increasing model for end-stage liver disease (MELD) score, a measure of disease severity. An age of 70 years or older did not independently predict death in transplant patients.

"In conclusion, biological and physiological variables may play a more important role than advanced age in predicting poor survival after liver transplantation. Measures of physiological age and risk of complications should be used in the evaluation process of elderly transplant candidates," the authors conclude. "Age by itself should not be used to limit liver transplantation."
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(Arch Surg. 2007;142(8):775-784. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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