The Passing of Time (To Transplantation)

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American Journal of Gastroenterology

What's New In GI

June 2001

Volume 96, Number 6

Page 1685

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The Passing of Time (To Transplantation)

T. McCashland, M.D.

Levy M, Somasundar P, Jennings L, et al. The elderly liver transplant

recipient: A call for caution. Ann Surg 2001;233:107-13.

The Baylor transplant group at Dallas reviewed their results of

elderly patients undergoing liver transplantation and evaluated factors to

predict poor outcomes in this subset of patients in a 13-yr retrospective

study. One thousand four hundred forty-six patients received transplants

over this time period; 9% were 61-65 yr old, and 5% were >66 yr. When

patients <60 yr old were compared to those >60 yr, etiologies of liver

disease and pretransplantation location/status were similar. Logistic

analysis identified, in descending order of importance (relative risk),

bilirubin level > 10 mg/dl (3.8), pretransplant location, hospital, or

intensive care unit (2.5), age > 60 yr (2.3), and donor age > 50 yr (2.2).

The raging debate over who and when a patient gets transplanted has

reached a crescendo. Previous reports have noted no difference in survival

of the elderly (>60 yr) patient. However, as waiting times continue to

increase, patients have gotten sicker while waiting, eliminating the likely

cherry picking of " more ideal elderly patients. " What this study has done

extremely well is to stratify elderly patients into risk categories. Several

lessons are learned. First, elderly patients with bilirubin levels of >10

mg/dl located in the intensive care unit should be questioned as to their

candidacy for transplantation. Second, especially in the elderly patients,

early referral may be of utmost importance.