Outcome of Liver Transplantation in Septuagenarians

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Vol. 142 No. 8, August 2007

Paper

Outcome of Liver Transplantation in Septuagenarians A Single-Center Experience

Gerald S. Lipshutz, MD, MS; Hiatt, MD; R. Mark Ghobrial, MD, PhD; G. Farmer, MD; M. ez, BA; Hasan Yersiz, MD; Gornbein, DrPH; W. Busuttil, MD, PhD

Arch Surg. 2007;142:775-784.

Hypothesis We hypothesized that selected septuagenarians may do as well after transplantation as those of a younger group of older recipients. This work compares post–liver transplant survival in septuagenarians with that of patients aged 50 to 59 years.

Design Review of a prospectively maintained database.

Setting University transplant center.

Patients First-time liver transplant recipients treated from January 1, 1988, to December 31, 2005. Group 1 consisted of liver transplant recipients aged 70 years or older at the time of transplant. Group 2 was a younger cohort of patients aged 50 to 59 years.

Interventions Liver transplantation.

Main Outcome Measures Patient survival. Survival data were stratified, Kaplan-Meier survival was calculated, and a multivariate analysis was performed.

Results Group 1 included 62 patients aged 70 years or older (average, 71.9 ± 2.1 years). Group 2 included 864 patients aged 50 to 59 years (average, 54.3 ± 2.9 years). Unadjusted patient survival of group 1 at 1, 3, 5, and 10 years was 73.3%, 65.8%, 47.1%, and 39.7%, respectively. Unadjusted patient survival of group 2 at 1, 3, 5, and 10 years was 79.4%, 71.5%, 65.3%, and 45.2%, respectively. The difference was not statistically significant (P = .14). Multivariate analysis for factors affecting survival demonstrated preoperative hospitalization, cold ischemia time, and hepatitis C/ethanol as risk factors for death. Age 70 years or more was not a strong risk factor (mortality ratio, 1.28; P = .27).

Conclusions When other risk factors for mortality are controlled in older recipients, risk of death due to age is reduced in well-selected recipients. Age by itself should not be used to limit liver transplantation.

Author Affiliations: Dumont-UCLA Transplant Center, Department of Surgery (Drs Lipshutz, Hiatt, Ghobrial, Farmer, Yersiz, and Busuttil and Ms ez), and Department of Biomathematics (Dr Gornbein), Geffen School of Medicine at UCLA, Los Angeles, California.