Liver transplantation in those of advancing age: The case for transplantation

✍ Scribed by Gerald S. Lipshutz; Ronald W. Busuttil

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 107 KB
• Volume: 13
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21089

✦ Synopsis

Longevity in the developed world continues to increase. In the United States from 1950 to 2005, those 65 to 75 yr of age increased twice as much as the overall annual growth rate of the population while those Ͼ75 yr increased 2.9 times as much. 1 Projections indicate that the rate of growth by 2050 for older age groups will continue to increase more than twice as rapidly as the total population (Fig. 1). It is expected that older patients will continue to seek advanced medical treatments as they age. How will this effect liver transplantation (LT)?

As longevity has increased, so has the burden of liver disease in those of advancing age. 2 As of October 27, 2006, there were 2,075 patients 65 yr or older on the United Network for Organ Sharing waiting list. 3 Similarly, the numbers of aged liver recipients has also increased. In 1988, 29 patients of age 65 or older underwent LT in the United States; in 2005, this number was 628, a 2100% increase (Fig. 2). 3 In this issue of Liver Transplantation, Cross et al. describe a series of patients from the King's College Hospital in London who underwent LT in the 7th decade of life. In a retrospective study from a prospectively maintained database, the authors compared the outcome of recipients aged 60 to 64 yr with those Ն65 yr at the time of transplantation. Results were further compared with a time-matched group of adult patients 18 to 59 yr old. Outcomes demonstrated no significant difference in survival for all 3 groups at 30-days, 1-yr, and 5-yr after LT; graft survival was similar to patient survival. However, the mean Model for End-Stage Liver Disease (MELD) score for those Ն65 yr was less than