The elderly liver transplant recipient : A call for caution

The increasing shortage of donor livers for transplantation has led to long waiting times, pretransplant (waiting list) death, and heated, bitter debates on the most suitable way to allocate these organs. Median waiting times nationwide are approaching 200 days; in certain parts of the country, patients may wait up to 2 years for a liver transplant. 1 These delays from waiting list placement to time of transplant inevitably translate into deaths of intended recipients. At our institution, waiting list deaths accrue at a rate of 20% of our adult liver transplant volume. Nationally, 10% of all adults die after being placed on the waiting list but before reaching transplant. 1 One consequence of this shortage has been mounting acrimony in the transplant community about organ allocation, with the federal government recently issuing directives. 2 Further, the governing board of the United Network for Organ Sharing accepted and implemented standardized criteria for placement on the liver transplant waiting list, with member-composed regional review boards to police the process. 1 For the clinician, other consequences include carefully reexamining the results of liver transplantation and avoiding organ uses that produce suboptimal results. 3,4 At our institution, we have become concerned that the results of liver transplantation in elderly recipients have in some cases been disappointing. In contrast, the transplant literature has steadfastly supported liver transplantation in elderly recipients. 5–8 The current study was undertaken to review the results of liver transplants in the elderly in a large single-center setting. A secondary goal was to define, if possible, factors that could help the clinician in the prudent allocation of the donor liver.