Liver Transplantation in the Elderly: An Evidence Based Review on Patient Outcome, Selection and Management Strategies

Abstract

There has been a steady increase in the age of potential recipients for liver transplantation over the past two decades. While patients older than age 60, on average, did not do as well as younger patients after transplantation, optimizing patient selection could minimize this discrepancy. It is appropriate to evaluate functional elderly patients without significant medical comorbidities for liver transplantation for the same indications as younger patients. For elderly patients with hepa-tocellular carcinoma and otherwise compensated liver disease, however, it is important to consider alternative treatment modalities that could provide similar survival. Elderly candidates who became too ill should be compassionately counseled away from transplantation based on existing prognostic models that can accurately predict post-transplant mortality. Finally, elderly transplant candidates and recipients may benefit from a more tailored management strategy in terms of donor risk matching and less immunosuppression.