Our experience in liver transplantation in patients over 65 yr of age

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Clinical Transplantation

Volume 22 Issue 1 Page 82-88, January/February 2008

To cite this article: Itxarone Bilbao, Cristina Dopazo, Lazaro, Castells, Alfredo Escartin, Iñigo , Gonzalo Sapisochin, Joaquin Balsells, Margarit (2008) Our experience in liver transplantation in patients over 65 yr of age Clinical Transplantation 22 (1), 82–88. doi:10.1111/j.1399-0012.2007.00749.x

Our experience in liver transplantation in patients over 65 yr of age

Itxarone Bilbaoaa Liver Transplant Unit, Department of Surgery, Cristina Dopazoaa Liver Transplant Unit, Department of Surgery, Lazaroaa Liver Transplant Unit, Department of Surgery, Castellsbb Hepatology Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain, Alfredo Escartinaa Liver Transplant Unit, Department of Surgery, Iñigo aa Liver Transplant Unit, Department of Surgery, Gonzalo Sapisochinaa Liver Transplant Unit, Department of Surgery, Joaquin Balsellsaa Liver Transplant Unit, Department of Surgery and Margarita†a Liver Transplant Unit, Department of Surgery†In memory of Professor Margarit, who was the Chief of Liver Transplant Unit from 1988 to December 9, 2005, when this study was conducted.

a Liver Transplant Unit, Department of Surgery and b Hepatology Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain

Itxarone Bilbao, Unidad de Trasplante Hepático, Hospital Vall d´Hebron, Paseo Vall d´Hebron nº 119-129, 08035 Barcelona, Spain.Tel.: +93 2746113; fax: +93 2746112;e-mail: ibilbao@...

†In memory of Professor Margarit, who was the Chief of Liver Transplant Unit from 1988 to December 9, 2005, when this study was conducted.

Bilbao I, Dopazo C, Lazaro JL, Castells L, Escartin A, I, Sapisochin G, Balsells J, Margarit C. Our experience in liver transplantation in patients over 65 yr of age.Clin Transplant 2007 DOI: © Blackwell Munksgaard, 2007

Abstract

Objectives: The aim of this study was to analyze short- and long-term results of liver transplantation (LT) in patients over 65 yr.

Material and methods: Between 1996 and 2004, 386 patients underwent 415 LT at our center. The main indication for LT was post-necrotic cirrhosis in 59%, followed by hepatocellular carcinoma (HCC) over cirrhosis in 33%. Half of the patients (53%) were hepatitis C virus (HCV) +. Overall, 72 patients were >65 yr of age. Actuarial survival, causes of mortality and postoperative complications were compared between groups: patients under and over 65 yr. Risk factors for poor outcome in patients over 65 yr were also analyzed.

Results: The older group had more patients at Child A stage, more HCC as an indication for LT and more HCV (+) patients, p < 0.05. No differences were observed in donor and surgery characteristics, except for lower multi-transfusion and higher incidence of grafts with steatosis in the older group (p < 0.05). Actuarial survival at one, three, five and 10 yr was 82%, 75%, 72%, and 70% for the <65 yr group vs. 77%, 66%, 55%, and 55% for the >65 yr group (p = 0.03). Main causes of mortality in patients >65 yr were recurrence of underlying disease and medical causes. In the older age group, fewer infections (p = ns) and rejections (p = 0.017) occurred in the postoperative period. Risk factor for poor outcome in the group of patients over 65 yr in multivariate analyses was pre-LT renal insufficiency (odds ratio 3.5, p = 0.002, 95% confidence interval 1.58–7.82).

Conclusion: Results in patients >65 yr are comparable to those <65 yr if older LT candidates are carefully selected. Overimmunosuppression should be avoided in older candidates, as its effects could worsen the pre-existing diseases common in elderly patients.