An increasing number of patients are referred to liver transplantation teams and there are more and more who gain access to the transplantation. How did you select elderly patients who had access to liver transplantation in your center?
While there are many younger candidates with more better predicted outcome and in the event of organ shortage, we must give the priority to younger patients.
However, i myself think if there are enough organs, a cirrhotic patient can not be excluded for transplantation just for age
Thanks Ahad and Vinay.
Many issues require further evaluation:
- Better define the selection criteria for aged candidates and how keeping them on the waiting list. Age is a substitute for many other comorbidities. What is the contribution of each?
- How to better guide the selection of older donors as the potential source of expansion of grafts pool for the elderly?
- Is it legitimate to develop aLDLT program specific to the elderly?
- How to improve clinical management by optimizing post-transplant immunosuppression with the implementation of specific protocols for elderly?
Dear Vincent,
Regarding your question about developing an elderly-specific LDLT program, elderly population is not uniform. As Vinay mentioned, physiologic and chronologic age may not show good correlation. We need to develop better selection criteria to offer LT to elderly population, like comorbidity indices. As a matter of fact, LDLT for septuagenarians also takes a lot of experience which is not easy to gather, because LDLT in this population is rare. Among more than 500 LDLT, we have only 10 such patients. Multi-institutional data would be a better source to search for an answer to your questions. I believe that ELTR database could provide an insight into this matter.
Dear Murat,
Sorry for the delay in my response because I no longer receive alerts from the website of ResearchGate.
Your idea is very interesting and actually we conducted a study in the septuagenrians which was presented at a conferenc a couple of years before. We have a publishing project that will soon be realized. Obviously, the evaluation of the results of LDLT as well as DCD and domino ... will be included in our project.
Dear Vincent,
Well then, I will look forward to the publication. I am really curious about the LDLT recipients. Meanwhile, we are currently writing an abstract on our septuagenerians who underwent LDLT (now the number is 12) to be presented at the next ILTS Congress.
At the U. of Miami, we do not have an age cut off, but those patients above 70 years old are evaluated and subsequently discussed in our Extreme Risk Board. If the patient is considered to be biologically strong enough, we place them in the list and reassess them periodically until transplantation time. At some point, we used extended criteria donor livers on some of those patients, but the results were not excellent
At our program we do not have an age cut off. Women above 70 compared to men are less likely to have an exclusion as they age. We have a general rule that we should hope to gain at least 10 years of life and if this holds true we would say yes to liver transplant. With this approach we have said yes to 2 women at age 72 who are now in their 80's and doing well.
Dear Leopold
Dear Thomas,
Thank you for the sharing of your experiences with the RG community. Indeed, we all agree that the transplantation of septuagenarians is possible provided to avoid some pre-LT risk factors and to adapt the post-LT chronic immunosuppression treatment.
I agree with my colleagues. Age is not a contraindications. However, a 70+ individual must have a good performance statue to undergo LT successfully. At Our program, cut off age is 70, but a good 70 is considered for LT. Moreover, if a 70+ has a living donor their transplant can be expedited.
I think that it depends of how your donation index could offer livers for your patients waiting a graft. If you have death in the waiting list, and if the mean of age still under 60, I disagree with transplantation of septuagenarians.
But if you have a good donation index and no death (lack of donor related) at the waiting list..
In Romania we have no septuagenarians, but patients over 65 yo have a poor outcome. probably the acces to common medical care is the cause, so people over 60 yo are sometimes with a poor control of theitr co- morbidities because the system has a scaricity of resources. So, act locally!
Generally the rule is to avoid transplante patients over 65 yo, but some particular excepciones may be analyzed case by case
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