Advanced age alone does not appear to be associated with an increased risk of death following liver transplant surgery, according to a new report by UCLA researchers.
The report, which appears in the August issue of Archives of Surgery, published by the American Medical Association, notes that life expectancy has increased in recent years, with individuals older than 70 representing a large and fast-growing segment of the general population. A healthy 70-year-old adult living in a developed country with a nutritious diet and good medical care can expect to live to age 80 or 90.
"As longevity has increased, the burden of liver disease in patients of advancing age has also increased and is associated with a higher mortality than in younger adults," the authors write. "In the 1980s, the death rate from chronic liver disease was highest in patients 65 to 74 years of age. This has led to more older patients undergoing liver transplantation."
Dr. Gerald S. Lipshutz, a UCLA associate professor of surgery, and his colleagues at the David Geffen School of Medicine at UCLA reviewed the records of patients who received their first liver transplant between 1988 and 2005 at the Dumont–UCLA Liver Transplant Program. They then compared survival times for 62 patients age 70 or older (average age 71.9) with 864 patients between the ages of 50 to 59 (average age 54.3). Survival time was measured until death, the last known follow-up date or retransplantation.
Overall, 31 of the 62 older patients and 345 of the 864 younger patients died during the study period. After one year, 73.3 percent of older patients and 79.4 percent of younger patients survived; after 10 years, 39.7 percent of older patients and 45.2 percent of younger patients were still alive.
"We found no statistically significant difference in survival in the first 10 years after transplantation for a group of 62 patients 70 years or older when compared with a younger cohort of 864 recipients aged 50 to 59 years with similar characteristics," the authors write. "The longest-surviving patient was 88 years old at 15 years after transplantation. One-year unadjusted survival of septuagenarians in the most recent surgical period, 2001 to 2005, was 94.4 percent."
The researchers also analyzed 26 variables related to the recipients, donors and transplant operations to see which predicted patient deaths. Of the 26, four were associated with death rates: preoperative hospitalization, a prolonged period of cold storage between liver removal and transplantation, cirrhosis caused by hepatitis C or alcohol, and an increasing score on the model for end-stage liver disease (MELD), which measures disease severity. An age of 70 years or older did not independently predict death in transplant patients.
"In conclusion, biological and physiological variables may play a more important role than advanced age in predicting poor survival after liver transplantation. Measures of physiological age and risk of complications should be used in the evaluation process of elderly transplant candidates," the authors conclude. "Age by itself should not be used to limit liver transplantation."
Established in 1984, the Dumont–UCLA Liver Transplant Program was one of the nation's first liver transplant programs and has since grown into one of the world's largest transplant centers. Its surgical team has performed more than 4,000 liver transplants. For more information, visit www2.healthcare.ucla.edu/transplant/liverhome.html.