Short and Long-Term Outcomes After Primary Liver Transplantation in Elderly Patients

• Authors: Michał Grąt , Oskar Kornasiewicz , Karolina Grąt , Arkadiusz Antczak , Joanna Ligocka , Wacław Hołówko , Karolina Maria Wronka , Konrad Kobryń , Michał Skalski , Leszek Pączek , Marek Krawczyk
• Languages of publication: EN

Abstracts

EN

The number of elderly patients undergoing liver transplantation (LT) is increasing worldwide. The aim of the study was to evaluate the impact of recipient age exceeding 60 years on early and long-term outcomes after LT. Material and methods. This study comprised data of 786 patients after primary LT performed at a single center between January 2005 and October 2012. Patients over and under 60 years of age were compared with respect to baseline characteristics and outcomes: postoperative mortality (90-day) and 5-year patient (PS) and graft (GS) survival. Associations between recipient age exceeding 60 years and LT results were assessed in multiple Cox regression models. Results. Recipients older than 60 years (n=107; 13.6%) were characterized by more frequent hepatitis C virus infections (p<0.001), malignancies (p<0.001), and cardiovascular comorbidities (p<0.001); less frequent primary sclerosing cholangitis (p=0.002) and Roux-en-Y hepaticojejunostomy (p<0.001); lower Model for End-stage Liver Disease (MELD; p=0.043); and increased donor age (p=0.012). Fiveyear PS of older and younger recipients was 72.7% and 80.6% (p=0.538), while the corresponding rates of GS were 70.3% and 77.5% (p=0.548), respectively. Recipient age exceeding 60 years was not significantly associated with postoperative mortality (p=0.215), PS (p=0.525) and GS (p=0.572) in multivariate analyses. The list of independent predictors comprised MELD (p<0.001) for postoperative mortality; malignancies (p=0.003) and MELD (p<0.001) for PS; and malignancies (p=0.003), MELD (p<0.001) and donor age (p=0.017) for GS. Conclusions. Despite major differences between elderly and young patients, chronological age exceeding 60 years alone should not be considered as a contraindication for LT.

Keywords

EN

liver transplantation; outcomes; elderly patients; recipient age; malignancies; donor age

• Journal: Polish Journal of Surgery
• Year: 2013
• Volume: 85
• Issue: 10
• Pages: 581-588

Dates

published

1 - 10 - 2013

online

01 - 12 - 2013

Contributors

author

Michał Grąt

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw,

author

Oskar Kornasiewicz

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

author

Karolina Grąt

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

author

Arkadiusz Antczak

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

author

Joanna Ligocka

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

author

Wacław Hołówko

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

author

Karolina Maria Wronka

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

author

Konrad Kobryń

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

author

Michał Skalski

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

author

Leszek Pączek

• Department of Immunology, Transplant Medicine and Internal Diseases, Transplantation Institute, Medical University in Warsaw

author

Marek Krawczyk

• Department of General, Transplant and Liver Surgery, Medical University in Warsaw

References

• 1. www.eltr.org (01.05.2013).
• 2. Pearse RM, Moreno RP, Bauer P et al.: Mortality after surgery in Europe: a 7 day cohort study. Lancet 2012; 380: 1059-65.[WoS][Crossref]
• 3. Mohd Hanafiah K, Groeger J, Flaxman AD et al.: Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013; 57: 1333-42.[PubMed][Crossref]
• 4. Rosińska M, Radziszewski F, Stepień M: Hepatitis C in Poland in 2010. Przegl Epidemiol 2012; 66: 287-92.
• 5. Kajko M, Slusarczyk J, Czarkowski M et al.: Demographic profile of a person with symptomatic hepatitis C in Poland. Przegl Epidemiol 2012; 66: 351-56.
• 6. Stepień M, Czarkowski MP: Hepatitis B in Poland in 2010. Przegl Epidemiol 2012; 66: 277-85.
• 7. Caputo F, Vignoli T, Leggio L et al.: Alcohol use disorders in the elderly: a brief overview from epidemiology to treatment options. Exp Gerontol 2012; 47: 411-16.[WoS][Crossref]
• 8. Krawczyk M, Grąt M, Barski K et al.: 1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw--analysis of indications and results. PolPrzegl Chir 2012; 84: 304-12.
• 9. Grąt M, Ligocka J, Lewandowski Z et al.: Incidence, pattern and clinical relevance of microbial contamination of preservation fluid in liver transplantation. Ann Transplant 2012; 17: 20-28.[PubMed]
• 10. Watt KD, Pedersen RA , Kremers WK et al.: Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK longterm follow-up study. Am J Transplant 2010; 10: 1420-27.[Crossref]
• 11. Parekh J, Corley DA, Feng S: Diabetes, hypertension and hyperlipidemia: prevalence over time and impact on long-term survival after liver transplantation. Am J Transplant 2012; 12: 2181-87.[Crossref][PubMed]
• 12. Roberts MS, Angus DC, Bryce CL et al.: Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database. Liver Transpl 2004; 10: 886-97.[PubMed][Crossref]
• 13. Krawczyk M, Grąt M, Barski K et al.: Analysis of long-term outcomes after liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw. Gastroenterol Pol 2012; 19: 43-50.
• 14. Krawczyk M, Grąt M, Kornasiewicz O et al.: Results of liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw in patients with chronic hepatitis B and C viruses infection. PrzeglEpidemiol 2013; 67: 5-10.
• 15. Patkowski W, Zieniewicz K, Skalski M et al.: Correlation between selected prognostic factors and postoperative course in liver transplant recipients. Transplant Proc 2009; 41: 3091-3102.[Crossref][WoS]
• 16. Cywinski JB, Mascha EJ, You J et al.: Pretransplant MELD and sodium MELD scores are poor predictors of graft failure and mortality after liver transplantation. Hepatol Int 2011; 5: 841-49.[WoS][Crossref]
• 17. Bonney GK, Aldersley MA, Asthana S et al.: Donor risk index and MELD interactions in predicting long-term graft survival: a singlecentre experience. Transplantation 2009; 87: 1858-63.[WoS][Crossref]
• 18. Zieniewicz K, Patkowski W, Nyckowski P et al.: Results of liver transplantation for hepatocellular cancer. Ann Transplant 2007; 12: 11-14.
• 19. Krawczyk M, Grąt M, Kornasiewicz O et al.: Liver transplantation in the treatment of patients with hepatocelular carcinoma. Pol Przegl Chir 2010; 82: 596-602.
• 20. Grąt M, Hołówko W, Grzegorczyk K et al.: Longterm results of liver resection in the treatment of patients with hepatocellular carcinoma. Pol PrzeglChir 2011; 83: 319-24.
• 21. Montalti R, Rompianesi G, Di Benedetto F et al.: Liver transplantation in patients aged 65 and over: a case-control study. Clin Transplant 2010; 24: E188-93.
• 22. Aduen JF, Sujay B, Dickson RC et al.: Outcomes after liver transplant in patients aged 70 years or older compared with those younger than 60 years. Mayo Clin Proc 2009; 84: 973-78.[PubMed]
• 23. Taner CB , Ung RL , Rosser BG et al.: Age is not a contraindication for orthotopic liver transplantation: a single institution experience with recipients older than 75 years. Hepatol Int 2012; 6: 403-07.[WoS]
• 24. Grąt M, Hołówko W, Lewandowski Z et al.: Early post-operative prediction of morbidity and mortality after a major liver resection for colorectal metastases. HPB (Oxford) 2013; 15: 352-58.
• 25. Grat M, Grzegorczyk K, Lewandowski Z et al.: Intraoperative injuries during liver resection: analysis of 1,005 procedures. Hepatol Int 2012; 6: 498-504. [WoS]

Identifiers

DOI

10.2478/pjs-2013-0087