Age Is Found No Barrier to Liver Transplants

LOS ANGELES, Aug. 20 -- Being 70 or older is no barrier to a liver transplant, researchers here said.
In an 18-year review of more than 900 orthotopic liver transplants, there was no survival difference between patients who were 70 or older and those who were ages 50 through 59, according to Ronald Busuttil, M.D., Ph.D., of the UCLA, and colleagues.
On the other hand, four other biological or physiological variables (of 26 considered) were found to be significant or near-significant predictors of death, Dr. Busuttil and colleagues reported in the August issue of Archives of Surgery.
The four were:
Cirrhosis caused by hepatitis C and alcohol, which carried a relative risk of death of 2.52, with a 95% confidence interval from 1.32 to 4.54, and was significant at P=0.006.
Preoperative hospitalization, which carried a relative risk of death of 1.54, with a 95% confidence interval from 1.05 to 2.28, and was significant at P=0.03.
An increasing Model for End-stage Liver Disease (MELD) score, which carried a relative risk of death of 1.014 per point, with a 95% confidence interval from 1.002 to 1.029, and was significant at P=0.04.
A prolonged period of cold storage between liver removal and transplantation, which carried a relative risk of death of 1.03 per hour, with a 95% confidence interval from 0.99 to 1.08, and was borderline significant at P=0.08.
But when the researchers compared survival outcomes -- between the 62 patients who were 70 or older at the time of transplant and the 864 who were in the younger group -- there was no significant difference.
Specifically, one-year, three-year, five-year and 10-year survival among the older group was 73.3%, 65.8%, 47.1%, and 39.7%, respectively. The comparable figures for the younger group were 79.4%, 71.5%, 65.3%, and 45.2%.
There was also no significant difference in overall survival, the researchers found -- although the relative risk of death was 1.28 in the older patients compared with the younger group, the P-value was 0.27
Indeed, the longest surviving patient was 88 at 15 years after transplantation, Dr. Busuttil and colleagues said.
The researchers said the study was limited by the small number of patients 70 or older, but added that it confirms previous work showing the importance of pre-transplant hospitalization and cold storage time.
The study implied that "biological and physiological variables may play a more important role than advanced age in predicting poor survival after liver transplantation," the researchers concluded.
When physicians evaluate older transplant patients, the process should include measures of physiological age and risk of complications, they added, noting that "chronological age by itself is not a sole predictor of outcome."
The researchers made no declaration of conflicts and did not report any outside support for the study.Primary source: Archives of SurgerySource reference: Lipshutz GS et al. Arch Surg. 2007;142(8):775-784.