title: Predictors of poor outcome among older liver transplant recipients.
abstract: With the increasing age of recipients undergoing orthotopic liver transplant (OLT), there is need for better risk stratification among them. Our study aims to identify predictors of poor outcome among OLT recipients ≥ 60 yr of age. All patients who underwent OLT at Cleveland Clinic from January 2004 to April 2010 were included. Baseline patient characteristics and post-OLT outcomes (mortality, graft failure, length of stay, and major post-OLT cardiovascular events) were obtained from prospectively collected institutional registry. Among patients ≥ 60 yr of age, multivariate regression modeling was performed to identify independent predictors of poor outcome. Of the 738 patients included, 223 (30.2%) were ≥ 60 yr. Hepatic encephalopathy, platelet counts < 45,000/μL, total serum bilirubin > 3.5 mg/dL, and serum albumin < 2.65 mg/dL independently predicted poor short-term outcomes. The presence of pre-OLT coronary artery disease and arrhythmia were independent predictors of poor long-term outcomes. Cardiac causes represented the second most common cause of mortality among the elderly cohort. Despite that, this carefully selected cohort of older OLT recipients had outcomes that were comparable with the younger recipients. Thus, our results show the need for better pre-OLT evaluation and optimization, and for closer post-OLT surveillance, of cardiovascular disease among the elderly.
authors.affiliation: Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Sonny
authors.forename: Dympna
authors.initials: D
authors.lastname: Kelly
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hammel
authors.forename: Mazen
authors.initials: M
authors.lastname: Albeldawi
authors.forename: Nizar
authors.initials: N
authors.lastname: Zein
authors.forename: Jacek B
authors.initials: JB
authors.lastname: Cywinski
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: age; cardiovascular disease; comorbidities; graft failure; mortality