Division of Surgical Transplantation, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Am Surg. 2023 Dec;89(12):5737-5743. doi: 10.1177/00031348231173998. Epub 2023 May 4.
The proportion of older patients on the liver transplant waitlist continues to increase. With limited existing data to guide liver transplant evaluation of elderly patients, we aimed to study selection practices and outcomes of patients ≥70 years old. We hypothesized that 1-year patient and graft survival would not differ between appropriately selected elderly patients and those who are younger.
All patients referred for liver transplantation between 2018 and 2020 were stratified into elderly (age ≥70) and young (age <70) cohorts. Evaluation data pertaining to medical, surgical, and psychosocial risk assessment were reviewed. Recipient characteristics and post-operative outcomes, primarily 1-year graft and patient survival, were compared, with a median follow-up of 16.4 months.
322 patients underwent transplant out of 2331 referred. Elderly patients represented 230 of these referrals and 20 underwent transplant. The most common reasons for denial of elderly patients were multiple medical comorbidities (49%), cardiac risk (15%) and psychosocial barriers (13%). The median MELD of elderly recipients was lower (19 vs 24, = .02), and proportion of hepatocellular carcinoma was higher (60% vs 23%, < .001). There was no difference in 1-year graft (elderly 90.9% vs young 93.3%, = .72) or patient survival (elderly 90.9% vs young 94.7%, = .88).
Liver transplant outcomes and survival are not affected by advanced age in carefully evaluated and selected recipients. Age should not be considered an absolute contraindication for liver transplant referral. Efforts should be made to develop guidelines for risk stratification and donor-recipient matching that optimize outcomes in elderly patients.
接受肝移植等待名单的老年患者比例持续增加。由于缺乏现有数据来指导对老年患者的肝移植评估，我们旨在研究年龄≥70 岁的患者的选择实践和结果。我们假设，经过适当选择的老年患者与年轻患者的 1 年患者和移植物存活率没有差异。
所有在 2018 年至 2020 年期间被转诊进行肝移植的患者被分为老年（年龄≥70 岁）和年轻（年龄<70 岁）两组。回顾了与医疗、手术和社会心理风险评估有关的评估数据。比较了患者特征和术后结果，主要是 1 年移植物和患者存活率，中位随访时间为 16.4 个月。
2331 例被转诊患者中有 322 例接受了移植。老年患者占这些转诊患者的 230 例，其中 20 例接受了移植。拒绝老年患者的最常见原因是多种合并症（49%）、心脏风险（15%）和社会心理障碍（13%）。老年受者的中位 MELD 较低（19 与 24，.02），肝癌比例较高（60%与 23%， <.001）。1 年移植物存活率（老年 90.9%与年轻 93.3%， =.72）和患者存活率（老年 90.9%与年轻 94.7%， =.88）无差异。
在经过仔细评估和选择的受者中，肝移植结果和存活率不受年龄的影响。年龄不应被视为肝移植转诊的绝对禁忌症。应努力制定风险分层和供体-受者匹配的指南，以优化老年患者的结局。
