Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 6/2020

Open Access 01-06-2020 | Liver Transplantation | Review Article

Liver transplantation in elderly patients: what do we know at the beginning of 2020?

Authors: Shimon Dolnikov, René Adam, Daniel Cherqui, Marc Antoine Allard

Published in: Surgery Today | Issue 6/2020

Login to get access

Abstract

An aging population has prompted us to evaluate the indications of liver transplantation (LT) in elderly patients more frequently. In this review, we summarize the short- and long-term results after LT in elderly patients and also discuss the criteria used to select patients and how recipient age can challenge current allocation systems. Briefly, the feasibility and early outcomes of LT in elderly patients compare favorably with those of younger patients. Although long-term survival is less than satisfactory, large-scale studies show that the transplant survival benefit is similar for elderly and younger patients. Therefore, age alone does not contraindicate LT; however, screening for cardiopulmonary comorbidities, and asymptomatic malignancies, evaluating nutritional status, and frailty, is crucial to ensure optimal results and avoid futile transplantation.
Literature
1.
Starzl TE, Brettschneider L, Groth CG. Liver transplantation. Bull Soc Int Chir. 1967;26:474–88.PubMed
2.
Shaw BW. Transplantation in the elderly patient. Surg Clin North Am. 1994;74:389–400.PubMed
3.
4.
Stieber AC, Gordon RD, Todo S, Tzakis AG, Fung JJ, Casavilla A, et al. Liver transplantation in patients over sixty years of age. Transplantation. 1991;51:271–3.PubMedPubMedCentral
5.
Schwartz JJ, Pappas L, Thiesset HF, Vargas G, Sorensen JB, Kim RD, et al. Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma: The national experience. Liver Transpl. 2012;18:423–33.PubMed
6.
Lipshutz G, Hiatt JR. Ghobrial, outcome of liver transplantation in septuagenarians a single-center experience. Arch Surg. 2007;142:10.
7.
Aduen JF, Sujay B, Dickson RC, Heckman MG, Hewitt WR, Stapelfeldt WH, et al. Outcomes after liver transplant in patients aged 70 years or older compared with those younger than 60 years. Mayo Clin Proc. 2009;84:973–8.PubMedPubMedCentral
8.
Wilson GC, Quillin RC, Wima K, Sutton JM, Hoehn RS, Hanseman DJ, et al. Is liver transplantation safe and effective in elderly (≥70 years) recipients? A case-controlled analysis. HPB. 2014;16:1088–94.PubMedPubMedCentral
9.
Taner CB, Ung RL, Rosser BG, Aranda-Michel J. Age is not a contraindication for orthotopic liver transplantation: a single institution experience with recipients older than 75 years. Hepatol Int. 2012;6:403–7.PubMed
10.
Kwon JH, Yoon YI, Song GW, Kim KH, Moon DB, Jung DH, et al. Living donor liver transplantation for patients older than age 70 years: a single-center experience. Am J Transplant. 2017;17:2890–900.PubMed
11.
Su F, Yu L, Berry K, Liou IW, Landis CS, Rayhill SC, et al. Aging of liver transplant registrants and recipients: trends and impact on waitlist outcomes, post-transplantation outcomes, and transplant-related survival benefit. Gastroenterology. 2016;150(441–453):e6.
12.
Aloia TA, Knight R, Gaber AO, Ghobrial RM, Goss JA. Analysis of liver transplant outcomes for United Network for Organ Sharing recipients 60 years old or older identifies multiple model for end-stage liver disease-independent prognostic factors. Liver Transpl. 2010;16:950–9.PubMed
13.
Englesbe MJ, Patel SP, He K, Lynch RJ, Schaubel DE, Harbaugh C, et al. Sarcopenia and mortality after liver transplantation. J Am Coll Surg. 2010;211:271–8.PubMedPubMedCentral
14.
Saab S. MELD score predicts 1-year patient survival post-orthotopic liver transplantation. Liver Transpl. 2003;9:473–6.PubMed
15.
Artru F, Louvet A, Ruiz I, Levesque E, Labreuche J, Ursic-Bedoya J, et al. Liver transplantation in the most severely ill cirrhotic patients: a multicenter study in acute-on-chronic liver failure grade 3. J Hepatol. 2017;67:708–15.PubMed
16.
Agopian VG, Harlander-Locke MP, Markovic D, Dumronggittigule W, Xia V, Kaldas FM, et al. Evaluation of early allograft function using the liver graft assessment following transplantation risk score model. JAMA Surg. 2018;153:436.PubMed
17.
Pareja E, Cortes M, Hervás D, Mir J, Valdivieso A, Castell JV, et al. A score model for the continuous grading of early allograft dysfunction severity: GRADING EARLY ALLOGRAFT DYSFUNCTION. Liver Transpl. 2015;21:38–46.PubMed
18.
Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16:943–9.PubMed
19.
Abdelfattah MR, Elsiesy H. Reappraisal of upper age limit for adult living-donor liver transplantation using right lobe grafts: an outcome analysis. Eur J Gastroenterol Hepatol. 2015;27:593–9.PubMed
20.
Sharpton SR, Feng S, Hameed B, Yao F, Lai JC. Combined effects of recipient age and model for end-stage liver disease score on liver transplantation outcomes. Transplantation. 2014;98:557–62.PubMedPubMedCentral
21.
Audet M, Piardi T, Panaro F, Cag M, Ghislotti E, Habibeh H, et al. Liver transplantation in recipients over 65 yr old: a single center experience. Clin Transplant. 2010;24:84–90.PubMed
22.
Montalti R, Rompianesi G, Di Benedetto F, Ballarin R, Gerring RC, Busani S, et al. Liver transplantation in patients aged 65 and over: a case-control study. Clin Transplant. 2010;24:E188–193.PubMed
23.
Bilbao I, Dopazo C, Lazaro JL, Castells L, Escartin A, Lopez I, et al. Our experience in liver transplantation in patients over 65 yr of age. Clin Transplant. 2008;22:82–8.PubMed
24.
Gómez Gavara C, Esposito F, Gurusamy K, Salloum C, Lahat E, Feray C, et al. Liver transplantation in elderly patients: a systematic review and first meta-analysis. HPB. 2019;21:14–25.PubMed
25.
Rana A, Hardy MA, Halazun KJ, Woodland DC, Ratner LE, Samstein B, et al. Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transplant. 2008;8:2537–46.PubMed
26.
Dutkowski P, Oberkofler CE, Slankamenac K, Puhan MA, Schadde E, Müllhaupt B, et al. Are there better guidelines for allocation in liver transplantation?: a novel score targeting justice and utility in the model for end-stage liver disease era. Ann Surg. 2011;254:745–54.PubMed
27.
Blok JJ, Putter H, Rogiers X, van Hoek B, Samuel U, Ringers J, et al. Combined effect of donor and recipient risk on outcome after liver transplantation: research of the eurotransplant database: risk on outcome after LT. Liver Transpl. 2015;21:1486–93.PubMed
28.
Adam R, Karam V, Delvart V, O’Grady J, Mirza D, Klempnauer J, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol. 2012;57:675–88.PubMed
29.
Brenner H, Hakulinen T. Age adjustment of cancer survival rates: methods, point estimates and standard errors. Br J Cancer. 2005;93:372–5.PubMedPubMedCentral
30.
Goldberg DS, Charlton M. Usefulness of liver transplantation in the elderly: the converging impact of risk and benefit. Gastroenterology. 2016;150:306–9.PubMed
31.
Garcia CE, Garcia RF, Mayer AD, Neuberger J. Liver transplantation in patients over sixty years of age. Transplantation. 2001;72:679–84.PubMed
32.
EASL Clinical Practice Guidelines. Liver transplantation. J Hepatol. 2016;64:433–85.
33.
Martin P, DiMartini A, Feng S, Brown R, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatol Baltim Md. 2014;59:1144–65.
34.
Møller S, Lee SS. Cirrhotic cardiomyopathy. J Hepatol. 2018;69:958–60.PubMed
35.
Carey WD, Dumot JA, Pimentel RR, Barnes DS, Hobbs RE, Henderson JM, et al. The prevalence of coronary artery disease in liver transplant candidates over age 50. Transplantation. 1995;59:859–64.PubMed
36.
An J, Shim JH, Kim S-O, Lee D, Kim KM, Lim Y-S, et al. Prevalence and prediction of coronary artery disease in patients with liver cirrhosis: a registry-based matched case-control study. Circulation. 2014;130:1353–62.PubMed
37.
Bernal W, Martin-Mateos R, Lipcsey M, Tallis C, Woodsford K, Mcphail MJ, et al. Aerobic capacity during cardiopulmonary exercise testing and survival with and without liver transplantation for patients with chronic liver disease: aerobic capacity in chronic liver disease. Liver Transpl. 2014;20:54–62.PubMed
38.
Plotkin JS, Scott VL, Pinna A, Dobsch BP, De Wolf AM, Kang Y. Morbidity and mortality in patients with coronary artery disease undergoing orthotopic liver transplantation. Liver Transplant Surg Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 1996;2:426–30.
39.
Yong CM, Sharma M, Ochoa V, Abnousi F, Roberts J, Bass NM, et al. Multivessel coronary artery disease predicts mortality, length of stay, and pressor requirements after liver transplantation. Liver Transpl. 2010;16:1242–8.PubMed
40.
Wray C, Scovotti JC, Tobis J, Niemann CU, Planinsic R, Walia A, et al. Liver transplantation outcome in patients with angiographically proven coronary artery disease: a multi-institutional study: post-LT survival after coronary angiography. Am J Transplant. 2013;13:184–91.PubMed
41.
Dick AAS, Spitzer AL, Seifert CF, Deckert A, Carithers RL, Reyes JD, et al. Liver transplantation at the extremes of the body mass index. Liver Transpl. 2009;15:968–77.PubMed
42.
Rendina M, Viggiani MT, Di Leo A, Barone M. Malnutrition, sarcopenia, and refractory ascites in end stage liver diseases: is there a way to climb back up? Dig Liver Dis. 2019;51:1513–4.PubMed
43.
Vidot H, Bowen DG, Carey S, McCaughan GW, Allman-Farinelli M, Shackel NA. Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites: ascites and frequency of paracentesis. JGH Open. 2017;1:92–7.PubMedPubMedCentral
44.
Chun JH, Ahn JY, Jung H-Y, Jung Park H, Kim GH, Lee JH, et al. Efficacy and complications of enteral feeding tube insertion after liver transplantation. Transplant Proc. 2015;47:451–6.PubMed
45.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–156.
46.
Carey EJ, Steidley DE, Aqel BA, Byrne TJ, Mekeel KL, Rakela J, et al. Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transpl. 2010;16:1373–8.PubMed
47.
Cron DC, Friedman JF, Winder GS, Thelen AE, Derck JE, Fakhoury JW, et al. Depression and frailty in patients with end-stage liver disease referred for transplant evaluation. Am J Transplant. 2016;16:1805–11.PubMed
48.
Lai JC, Feng S, Terrault NA, Lizaola B, Hayssen H, Covinsky K. Frailty predicts waitlist mortality in liver transplant candidates: frailty in liver transplant candidates. Am J Transplant. 2014;14:1870–9.PubMedPubMedCentral
49.
50.
Wang CW, Covinsky KE, Feng S, Hayssen H, Segev DL, Lai JC. Functional impairment in older liver transplantation candidates: from the functional assessment in liver transplantation study: functional impairment in older LT candidates. Liver Transpl. 2015;21:1465–70.PubMed
51.
Levy MF, Somasundar PS, Jennings LW, Jung GJ, Molmenti EP, Fasola CG, et al. The elderly liver transplant recipient: a call for caution. Ann Surg. 2001;233:107–13.PubMedPubMedCentral
52.
Herrero JI, Lucena JF, Quiroga J, Sangro B, Pardo F, Rotellar F, et al. Liver transplant recipients older than 60 years have lower survival and higher incidence of malignancy. Am J Transplant. 2003;3:1407–12.PubMed
53.
Kim J, Ko ME, Nelson RA, Arrington A, Luu C, Falor AE, et al. Increasing age and survival after orthotopic liver transplantation for patients with hepatocellular cancer. J Am Coll Surg. 2014;218:431–8.PubMed
54.
Tschuor C, Ferrarese A, Kuemmerli C, Dutkowski P, Burra P, Clavien P-A, et al. Allocation of liver grafts worldwide—Is there a best system? J Hepatol. 2019;71:707–18.PubMed
55.
de Boer JD, Putter H, Blok JJ, Alwayn IPJ, van Hoek B, Braat AE. Predictive capacity of risk models in liver transplantation. Transpl Direct. 2019;5:e457.
56.
Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA, et al. Characteristics associated with liver graft failure: the concept of a donor risk index: characteristics associated with liver graft failure. Am J Transplant. 2006;6:783–90.PubMed
57.
Braat AE, Blok JJ, Putter H, Adam R, Burroughs AK, Rahmel AO, et al. The eurotransplant donor risk index in liver transplantation: ET-DRI: donor risk factors in liver transplantation within eurotransplant. Am J Transpl. 2012;12:2789–96.
58.
Ross LF, Thistlethwaite JR. Age should not be considered in the allocation of deceased donor kidneys. Semin Dial. 2012;25:675–81.PubMed
59.
Cucchetti A, Ross LF, Thistlethwaite JR, Vitale A, Ravaioli M, Cescon M, et al. Age and equity in liver transplantation: an organ allocation model: prudential lifespan account in LT. Liver Transpl. 2015;21:1241–9.PubMed
60.
61.
Werkgartner G, Wagner D, Manhal S, Fahrleitner-Pammer A, Mischinger HJ, Wagner M, et al. Long-term quality of life of liver transplant recipients beyond 60 years of age. Age. 2013;35:2485–92.PubMedPubMedCentral
62.
Keswani RN, Ahmed A, Keeffe EB. Older age and liver transplantation: a review. Liver Transpl. 2004;10:957–67.PubMed
63.
Rudich S, Busuttil R. Similar outcomes, morbidity, and mortality for orthotopic liver transplantation between the very elderly and the young. Transplantation. 1999;31:1–2.
64.
Safdar K, Neff GW, Montalbano M, Meyer D, O’Brien C, Yamashiki N, et al. Liver transplant for the septuagenarians: importance of patient selection. Transpl Proc. 2004;36:1445–8.
65.
Oezcelik A, Dayangac M, Guler N, Yaprak O, Erdogan Y, Akyildiz M, et al. Living donor liver transplantation in patients 70 years or older. Transplantation. 2015;99:1436–40.PubMed
66.
Sharma M, Ahmed A, Wong RJ. Significantly higher mortality following liver transplantation among patients aged 70 years and older. Prog Transpl. 2017;27:225–31.
67.
Gil E, Kim JM, Jeon K, Park H, Kang D, Cho J, et al. Recipient age and mortality after liver transplantation: a population-based cohort study. Transplantation. 2018;102:2025–32.PubMedPubMedCentral
68.
Mousa OY, Nguyen JH, Ma Y, Rawal B, Musto KR, Dougherty MK, et al. Evolving role of liver transplantation in elderly recipients. Liver Transpl. 2019;25:1363–74.PubMed
Metadata
Title
Liver transplantation in elderly patients: what do we know at the beginning of 2020?
Authors
Shimon Dolnikov
René Adam
Daniel Cherqui
Marc Antoine Allard
Publication date
01-06-2020
Publisher
Springer Singapore
Published in
Surgery Today / Issue 6/2020
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-020-01996-7

Other articles of this Issue 6/2020

Surgery Today 6/2020 Go to the issue

Original Article

Significance of fistulography findings to the healing time of postoperative pancreatic fistula after pancreaticoduodenectomy

Original Article

Effects of a new perioperative enhanced recovery after surgery protocol in hepatectomy for hepatocellular carcinoma

Original Article

Stapler sizes optimized for pancreatic thickness can reduce pancreatic fistula incidence after distal pancreatectomy

Correction

Correction to: Safety and efficacy of preoperative chemotherapy followed by esophagectomy versus upfront surgery for resectable esophageal squamous cell carcinoma

Review Article

Surgical intervention for ischemic mitral regurgitation: how can we achieve better outcomes?

Original Article

Clinical role of serum programmed death ligand 1 in patients with hepatocellular carcinoma: Where does it come from?