Liver transplant recipients older than 60 years have lower survival and higher incidence of malignancy.
Older age is not considered a contraindication for liver transplantation, but age-related morbidity may be a cause of mortality. Survival and the incidence of the main post-transplant complications were assessed in 111 adult liver transplant recipients. They were divided in two groups according to their age (patients younger than 60 years, n=54; patients older than 60 years, n=57) and both groups were compared. Older patients were more frequently transplanted for hepatitis C (p= 0.03) and hepatocellular carcinoma (p= 0.05) and their liver disease was less advanced (Child-Pugh and MELD scores were significantly lower; p=0.004 and p=0.05, respectively). After transplantation, older patients had a significantly lower survival (p=0.02). Higher age was independently associated with mortality (hazard ratio for each 10-year increase: 2.1; 95% confidence interval: 1.1- 4.0; p=0.02). The incidence of de novo neoplasia and nonskin neoplasia were higher in older patients (p=0.02 and p =0.007, respectively). Malignancy was the cause of death in one patient younger than 60 years and in 12 patients older than 60 years (p =0.002). In multivariate analysis, a higher age and smoking were independently associated with a higher risk of dying of de novo neoplasia. In conclusion, older liver transplant recipients have a significantly lower survival than younger patients. Malignancy is responsible for this decreased survival.
Herrero
J Ignacio
JI
Department of Surgery, Clínica Universitaria, Pamplona, Spain. iherrero@unav.es
Lucena
Juan Felipe
JF
Quiroga
Jorge
J
Sangro
Bruno
B
Pardo
Fernando
F
Rotellar
Fernando
F
Alvárez-Cienfuegos
Javier
J
Prieto
Jesús
J
D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology; D002423:Cause of Death; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006526:Hepatitis C / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013997:Time Factors
D007166:Immunosuppressive Agents