Kleb C, Faisal MS, Quintini C, Miller CM, Menon KVN, Modaresi Esfeh J. Factors predicting futility of liver transplant in elderly recipients: A single-center experience. World J Transplant 2021; 11(10): 421-431 [PMID: 34722171 DOI: 10.5500/wjt.v11.i10.421]
Corresponding Author of This Article
Jamak Modaresi Esfeh, MD, Assistant Professor, Department of Gastroenterology & Hepatology, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, United States. modarej@ccf.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Oct 18, 2021; 11(10): 421-431 Published online Oct 18, 2021. doi: 10.5500/wjt.v11.i10.421
Factors predicting futility of liver transplant in elderly recipients: A single-center experience
Cerise Kleb, Muhammad Salman Faisal, Cristiano Quintini, Charles M Miller, K V Narayanan Menon, Jamak Modaresi Esfeh
Cerise Kleb, Muhammad Salman Faisal, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Cristiano Quintini, Charles M Miller, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
K V Narayanan Menon, Jamak Modaresi Esfeh, Department of Gastroenterology & Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Kleb C designed, performed the research and wrote the paper; Faisal MS contributed to the design of the study and performed analysis of the data; Quintini C, Miller CM and Menon KN helped with critical revisions of the study; Modaresi Esfeh J supervised, helped design the study, made critical revisions to the manuscript and gave final approval.
Institutional review board statement: This study was reviewed and approved by the Cleveland Clinic Foundation Institutional Review Board.
Informed consent statement: This study qualified by a Waiver of Informed Consent as determined by our hospital’s IRB as it was a retrospective study that involved no more than minimal risk to the subjects, could not be reasonably carried out without the waiver, and was not a threat to the rights or welfare of the subjects.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jamak Modaresi Esfeh, MD, Assistant Professor, Department of Gastroenterology & Hepatology, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, United States. modarej@ccf.org
Received: February 23, 2021 Peer-review started: February 23, 2021 First decision: May 3, 2021 Revised: May 19, 2021 Accepted: September 19, 2021 Article in press: September 19, 2021 Published online: October 18, 2021
ARTICLE HIGHLIGHTS
Research background
The average age of patients awaiting liver transplant (LT) in the United States is increasing. Previous research on the effect of age on post-LT outcomes has produced conflicting results.
Research motivation
The donor pool for LT remains limited and donor organs is a precious resource. Thus, avoiding futility of transplant is important.
Research objectives
The objective of this study was to identify factors associated with futility of LT in elderly patients, to help inform the decision whether or not to list elderly patients with liver disease for transplant. We also aimed to investigate relevant post-transplant outcomes in elderly patients.
Research methods
This study included all patients above the age of 45 who underwent LT at our center over a ten-year period (2010-2020). Of these patients, 260 were 65 years of age or older. In the elderly cohort, several patient factors were analyzed to determine if they were associated with a “futile” outcome defined as death within 90 d after transplant. We also analyzed three different age groups for secondary outcomes such as hospital length of stay (LOS), intensive care unit LOS and discharge to facility.
Research results
Diastolic congestive heart failure (CHF) was independently associated with futility of LT after adjusting for potential confounders. Elderly LT recipients had higher one year mortality, longer hospital LOS and were more likely to be discharged to a facility.
Research conclusions
Diastolic CHF may be a prognostic indicator for futility of LT in elderly patients. This comorbidity should be considered as part of the pre-LT evaluation.
Research perspectives
Further research is needed with a larger sample size, perhaps including multiple centers to determine if there are any other patient comorbidities (or other factors such as functional status and primary cause of liver disease) are associated with futility of LT in elderly patients.
