Medscape Article - Older Patients Do Well After Liver Transplantation

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Older Patients Do Well After Liver Transplantation

By Rizzo

NEW YORK (Reuters Health) Oct 09 - Results of a study suggest that patients 60 or 65 years old who undergo liver transplantation have 1-year and 5-year survival rates similar to those of younger patients. These older patients also experience fewer episodes of rejection, according to the research team.

"An increasing number of patients are undergoing liver transplantation assessment for decompensated end stage liver disease," state Dr. A. Heneghan and colleagues from King's College Hospital in London. "This situation has led to a re-evaluation of selection criteria for liver transplantation, so that both survival outcomes and organ allocation are optimized."

The researchers report their experience with patients who underwent liver transplantation between 1988 and 2003. They retrospectively examined patients and graft survival among those who were older than 65 years at the time of transplantation (group 1, n = 77) and compared them with those who were between 60 and 64 years of age (group 2, n = 137), and 18 to 59 years (group 3, n = 202) at the time of transplantation.

The mean ages at the time of the procedure for groups 1, 2, and 3 were 67 years, 62 years, and 42 years, respectively. Thirty-day survival was 99% for patients in group 1, 94% for those in group 2, and 94% for those in group 3, the investigators report in the October issue of Liver Transplantation. Corresponding survival rates at 1 year were 82%, 86%, and 83%. The 5-year survival was 73%, 80%, and 78%, respectively.

There were a total of 218 episodes of ACR in the three groups, with no significant difference between groups observed.

"Older patients should not necessarily be denied liver transplantation as long as a comprehensive screen for comorbidity is undertaken as part of the transplant assessment process," Dr. Heneghan told Reuters Health.

"Since older patients have less rejection, immunologically, there may be an advantage in this cohort of patients in terms of attempting more systematic immunosuppression reduction or indeed immunosuppression withdrawal," Dr. Heneghan said. "In addition, since immunosuppression in the form of anti-rejection therapy is associated with an increased risk of malignancy, reducing anti-rejection therapy may be advantageous for this group of patients in particular."

Liver Transpl 2007;13:1382-1388.