Patients over age 60 do well after liver trans...(difference in the number of rejection ep...),Health

The researchers theorized that the strong survival rates among older patients might be due to a more rigorous assessment of co-morbidities, a higher proportion of patients with primary biliary cirrhosis and lower mean MELD scores. The older patient cohorts may reflect a selection bias of patients who are deemed likely to have a good outcome from liver transplantation despite their age, the authors report.

Among patients who did not survive, cardiovascular causes were most common for patients under 65, while malignancy and sepsis were most common among patients over 65. The researchers theorized that age-related immune system weakness led to less rejection, while at the same time putting the transplant recipients at risk for infection and cancer.

While the study was limited by the fact that all patients were from one medical center, and they were not etiology matched, the results strongly suggest that liver transplantation should not be denied from older recipients on the basis of age alone, the authors conclude. Based on their lower rejection rates and excellent graft survival, they might benefit from strategies geared towards immunosuppression withdrawal and tolerance induction. However long-term follow up of these patients is warranted.

In an accompanying editorial, Ronald Busuttil and Gerald Lipshutz suggest that the data will add important information to the debate on who can and should undergo liver transplantation. While age should not be a sole criterion, they add, unless there is growth in the number of donor livers, there will continue to be debate about rationing and donor/recipient matching for this limited resource.

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