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

100%

Grąt M., Kornasiewicz O., Grąt K., Antczak A., Ligocka J., Hołówko W., Wronka K. M., Kobryń K., Skalski M., Pączek L., Krawczyk M.

vol. 85

issue 10

581-588

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.

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results

47%

Krawczyk M., Grąt M., Barski K., Ligocka J., Antczak A., Kornasiewicz O., Skalski M., Patkowski W., Nyckowski P., Zieniewicz K., Grzelak I., Pawlak J., Alsharabi A., Wróblewski T., Paluszkiewicz R., Najnigier B., Dudek K., Remiszewski P., Smoter P., Grodzicki M., Korba M., Kotulski M., Cieślak B., Kalinowski P., Gierej P., Frączek M., Rdzanek Ł., Stankiewicz R., Kobryń K., Nazarewski Ł., Leonowicz D., Urban-Lechowicz M., Skwarek A., Giercuszkiewicz D., Paczkowska A., Piwowarska J., Gelo R., Andruszkiewicz P., Brudkowska A., Andrzejewska R., Niewiński G., Kilińska B., Zarzycka A., Nowak R., Kosiński C., Korta T., Ołdakowska-Jedynak U., Sańko-Resmer J., Foroncewicz B., Ziółkowski J., Mucha K., Senatorski G., Pączek L., Habior A., Lechowicz R., Polański S., Leowska E., Pacho R., Andrzejewska M., Rowiński O., Kozieł S., Żurakowski J., Ziarkiewicz-Wróblewska B., Górnicka B., Hevelke P., Michałowicz B., Karwowski A., Szczerbań J.

Polish Journal of Surgery

2012

vol. 84

issue 6

304-312

The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

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

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results